FATTY ILLS 

AND THEIR MASQUERADES 



BY 



EPHRAIM CUTTER, LL.D., 

M,D. Harvard, 1856, and University of Penn- 
sylvania, 1857 



AND 



JOHN ASHBURTON CUTTER, B.Sc, 

M.D. Albany Medical College, 1886 
Corroborator 



Being a contribution to clinical medicine for practitioners 
and students, to emphasize the inestimable value of 
the microscope in detecting the pre-stages of amaurosis, 
angina pectoris, apoplexy, Bright's disease, cataract, 
dementia, fatty heart, gall stones, glaucoma, hsemato- 
philia, locomotor ataxia, etc., and the like value of 
American means of treatment in these pre-stages and 
in those advanced states usually considered incurable 



Equitable Building 
120 Broadway, New York 

THE AUTHORS 

I89S 




1*3 



This matter herewith published was delivered in 

part by lectures to the College of Physicians 

and Surgeons of Boston by the prime 

writer during 1894-95, 



Copyright, January, 1898, by Ephraim Cutter 
and John Ashburton Cutter 



M 

|?i*fer of 

IVED. 



J*> 



\ ^ ^ Vo 



Press of STKTTINKR BROS., 

22-26 Reade Street, 

New York 



TABLE OF CONTENTS. 



DEDICATION, V-VI 

PRELUDE, VII-VIII 

DEFINITIONS IX-XIV 

I. FATTY DEGENERATIONS THAT 

ARE NORMAL, i 

II. FATTY ILLS WHICH ARE AB- 
NORMAL AND RECOGNIZED AS 
FATTY DEGENERATION, . . 3 
III. MASQUERADES OF FATTY ILLS, 3b 
IV. FATTY DEGENERATION A PRE- 
SERVATIVE PROCESS, . . 60 
V. THE DIAGNOSIS OF FATTY DE- 
GENERATIONS, .... 61 
VI. THE TREATMENT OF THE FATTY 
ILLS AND THEIR MASQUE- 
RADES, 79 

VII. SPECIAL AND PARTICULAR 

TREATMENT, WITH ILLUS- 
TRATIVE CASES, . . .140 

VIII. BIBLIOGRAPHY, 177 

IX. APPENDICES, . . . . . 1S1 

X. INDEX, '" . 1S7 



DEDICATED 

TO 

DR. G. N. TIENHOVEN, 
Physician to the Queen of Holland, etc. 

DR. FREDERICK SEMELEDER, 
Surgeon-in-Chief to Maximilian, in Mexico, etc. 

DR AUGUST MARTIN, 
Chairman of the Section on Gynecology, Tenth Inter- 
national Medical Congress, etc. 

SIR JOHN BANKS, K.C.B., 
Dublin. 

SURGEON-MAJOR J. H. JOHNSTON, B.A., 

Aldershot. 

LEWIS A. SAYRE, M.D., 
President American Medical Association, 1880; Emeri- 
tus Professor of Orthopaedic Surgery, Bellevue 
Hospital Medical College, etc. 

T. GAILLARD THOMAS, M.D., LL.D., 
Emeritus Professor of Gynecology, College of Physi- 
cians and Surgeons, New York, etc. 

ALBERT VANDER VEER, M.D., Ph.D., 
Professor of Surgery, Albany Medical College; Re- 
gent of the University of the State of New York, 
etc. 

JOHN B. HAMILTON, M.D., LL.D., 

Supervising Surgeon-General, Marine Hospital Ser- 
vice of the United States, 1879 to l $9 l \ Professor 
Principles of Surgery and Clinical Surgery, Rush 
Medical College; editor "Journal of the American 
Medical Association," etc. 

ROBERT NEWMAN, M.D., 

President American Electro-Therapeutic Society, etc. 

V 



DEDICATION. 

HENRY A. ROBBINS, A.M.,M.D., 
Washington, D. C. 

PROF. S.WEIR MITCHELL, M.D., LL.D., 

Clinician, author, etc., of Philadelphia. 

PROF. J. SOLIS COHEN, M.D., 

Philadelphia. 

JOHN V. SHOEMAKER, M.D., LL.D., 

Professor of Materia Medica, Pharmacology, and 
Therapeutics, Medico-Chirurgical College; editor of 
the " Medical Bulletin," etc. 

HENRY O. MARCY, M.D.,LL.D., 

President American Medical Association, etc. 

SAMUEL W. ABBOTT, A.M., M.D., 
Secretary Massachusetts Board of Health, etc. 

AUGUSTUS P. CLARKE, M.D., 
Dean of the College of Physicians and Surgeons, Bos- 
ton; Honorary President Section on Gynecology, 
Twelfth International Congress, 1897, etc. 

G. ARCHIE STOCKWELL, M.D., 

Editor of the "Medical Age," etc. 
I. N. LOVE, M.D., 
President Mississippi Valley Medical Association; edi- 
tor of the " Medical Mirror," etc. 

LANDON B. EDWARDS, M.D., 
Professor of Practice of Medicine, University College 
of Medicine; editor "Virginia Medical Semi- 
Monthly," etc. 

LEVI C, LANE, M.D., LL.D., 

Founder Cooper Medical College, San Francisco. 

GUSTAVUS L. SIMMONS, M.D., 
President California State Medical Society. 

DEERING J. ROBERTS, M.D. 

Editor " Southern Practitioner," Tennessee. 

PROF. DUDLEY S. REYNOLDS, M.A., M,D., 

Louisville. 

SAMUEL K. CRAWFORD, M.D., 

Chicago, 111. 

vi 



PRELUDE. 



The prevalence and fatality of diseases 
whose essence is fatty degeneration make 
them a subject of importance, especially as it 
is now, though not generally, known that they 
are curable. To have this fully understood 
means a rewriting of the science and art of 
medicine, as chemistry and electricity are 
being rewritten within the last twenty or more 
years. But this is no hardship, since the busi- 
ness of the medical profession is to cure dis- 
eases as well as to write them up. If there is 
any light to throw on fatty degenerations, 
there is need of such writing, regardless of 
the personal equations of the illuminator and 
the illuminated. So if this dark subject is 
made brighter and clearer, or if a cue is given 
to make it clearer and brighter, the end will 
be gained, which is to show : 

I. What fatty degenerations are normal. 

II. What fatty degenerations are abnormal. 

III. The fatty degenerations that are mas- 
querades — *.*., diseases which really are fatty 
ills, but which are called by other names giv- 
ing no idea of their true character and are 
therefore misleading. 

IV. That fatty degeneration is supposed to be 
a preservative process. 

V. The diagnosis of fatty degeneration : 

(a) By the morphology of the blood. 

(b) By the morphology of muscular tissue. 

(c) By the morphology and chemistry ©f 

the urine. 

vii 



Vlll 

(a) By auscultation, percussion, mensu- 
ration, palpation. 

VI. The treatment — by food, by medicines, 
by forms of motion such as music, vital dy- 
namis, massage, and by proper management, 
illustrating the highest art of the physician. 

VII. Special and particular treatment, with 
illustrative cases. 

VIII. Partial bibliography. 

EPHRAIM CUTTER. 



Note. — The corroborator has had little to do with 
the actual writing of this clinical contribution to medi- 
cine beyond the case histories in his own practice and 
some suggestions and emendations to the manuscript. 
He witnesses to the value and truth of what is herein 
laid down. 

JOHN ASHBURTON CUTTER. 



DEFINITIONS. 

WHAT IS MEANT BY FATTY DEGENERATION ? 

''It is the replacing or substitution of nor- 
" mal tissues or parts of normal tissues by 
" some form of liquid, solid, crystalline, cel- 
" lular, intercellular, or interstitial fat," or 
" the abnormal deposition of fatty matters in 
" the histological elements of animal bodies" 
(Micrographic Dictionary, London, 1883). 

To use language, as we do when we say 
"the sun rises/' to set forth a perfectly in- 
telligible fact though not scientifically ex- 
pressed, we mean that fatty degeneration in- 
cludes the oily, the lardaceous, the waxy, the 
hyaline, the tallowy, and the amyloid and 
sclerotic degenerations sometimes accom- 
panied by beautiful pigments and calcareous 
deposits. As a general thing, fatty degenera- 
tions are recognized after death with ease; 
but it is the duty of physicians to recognize 
fatty ills before death by the use of a means 
of knowledge which the Nederlands conferred 
on the world three hundred years ago — i.e., 
by the microscope. 

TWO GREAT PRIME CAUSES. 

First. The English idea is that fatty ills 
are "due to retarded or impeded functions 
or circulation"; or that "when the normal 
functions of the morphological elements of a 
tissue become languid or interrupted, free 
globules of fat or oil become deposited in 
them; and, as this fatty deposit is increased, 
the tissue loses, to a greater or lesser extent, 
ix 



its natural vital and physical properties, and 
hence is said to be in a state of fatty de- 
generation ° ( Micrographic Dictionary). 

This is seen in the destruction of horses by 
high feeding without proper exercise. Veter- 
inarians say that the muscles turn into fat. 

When ligatures about human limbs do 
not wholly obstruct the circulation, the 
effect is to produce fatty degeneration, 
especially of the muscles. Henry O. Marcy , 
M.D., LL.D., reports a case where he per- 
formed cholecystotomy for stones impacted 
in the gall bladder, and found even the 
fibrous tissues of the gall bladder fattily 
degenerated and rotten, partly due to the 
enormous pressure exerted by the stones. 

This causal principle of pressure holds 
true of the vegetable kingdom as well as 
of the animal. Some years ago I studied 
the morphology of New England autum- 
nal foliage. In the maple leaf, for exam- 
ple, it was found that the stem ducts were 
half-obliterated by a hyaline, glassy sub- 
stance evenly deposited inside the walls of 
the ducts; that the interlaminal parenchy- 
ma of the leaf was well filled with granular 
and globar fat, and that the chlorophyll 
was undergoing other molecular changes 
which seemed to be due to cutting down 
of the sap supply by the aforesaid diminu- 
tion in the normal calibre or lumen of the 
stem ducts. 

Again, in studying the morphology of 
rotten apples, I took an apple with a 
smooth facet made by the barrel-head, 
which facet looked discolored and rotten. 
Cutting into it, the substance felt hard 
and inelastic in place of soft and punky. 
This unexpected feel caused a careful 
microscopic examination, which showed 
an abundance of starch-like (amyloid) 
bodies, along with fat globules and gran- 



XI 

ules. I thought to find broken-down cells 
of apple protoplasm gracefully entwined 
with exquisitely fine mycelia of the fully 
developed fungus of rotten-apple fermen- 
tation vegetation. It seemed to me that 
the long-continued pressure of the barrel- 
head on the apple had retarded the inter- 
and intracellular circulation of the apple 
fluids; and hence, according to this doc- 
trine, resulted the fatty degeneration. At 
least, this rationale is satisfactory till a 
better appears. Apple amyloid has been 
found in the bark by others, but not be- 
fore in the apple substance, according to 
my knowledge. The fat formed in corn, 
peach stones, nuts, and in suet meats is 
normal fat. 

Second Great Cause— Fatty Ills Come 
from Food. 

(a) Fatty food in excess, as seen in the 
production of the fatty liver of Strassburg 
geese kept in close confinement, as a gour- 
mand's delicacy; and as shown by experi- 
ments in feeding animals on fat foods, 
reported in text books of physiology. 

(b) Food in excess containing carbon, hy- 
drogen, and oxygen, as seen in fruits, sugars 
cakes, candies, pies,and other such produc- 
tions of the vegetable and animal king- 
doms which have few mineral elements 
and are mostly made up of carbohydrates, 
as fats are. (See list of sugars, Appen- 
dix B.) That is to say, we must ex- 
pect fatty ills to occur when the food is 
of the same ultimate chemical elements as 
fat, but differently arranged in molecular 
combination. For example, an exclusive 
diet of starch, if it could be lived on long 
enough, should be expected to produce 
the substitution of normal tissues by fat. 



Xll 

Dr. W. A. Hammond once tried to live on 
starch alone, but the results were so dis- 
astrous that his friends obliged him to 
desist. Dogs fed on white flour alone died 
in forty days. Dogs lived on water alone 
for forty days. 

The late Joseph Jones, M.D., LL.D.,by 
experiments in changing the food of car- 
nivorous chelonians to vegetable food — i.e. 
pursley — showed fatty degeneration as 
one result (Smithsonian Contributions to 
Knowledge, 1856). 

To repeat : As fats are carbon, hydrogen, 
and oxygen, and as starches and sugars, 
wherever found, are carbon, hydrogen, and 
oxygen, it is natural, from a chemical point 
of view, to expect fatty degeneration to 
result from feeding on starch and sugar 
foods exclusively. The phyto-chemistry 
of our bodies is something wonderful; but 
it would be more wonderful if from car- 
bon, hydrogen, and oxygen it could evolve 
lime, phosphorus, sulphur, fluorine, and 
the other ultimate chemical elements 
which are part and parcel of our bodies.* 
(c) But there is an A merican idea as to the 
cause of fatty degeneration, which is all- 
operative, cogent, impressive, positive, and 
often must be present, to wit: that the fer- 
mentation of food in the alimentary canal 
produces gases which directly and in- 
directly paralyze, impede, and hinder func- 
tions, so that the gases act very much as 
if the circulations connected with said 
functions were obstructed mechanically by 
a string or ligature. This division might 
come under our first head, and also might 
come under the second head, as carbo- 
hydrates constitute the most fermentable 

* Some chemists claim forty elements in the human 
body. 



Xlll 

foods. Its unrecognized importance en- 
titles it to a distinct recognition and sep- 
arate statement; besides this, it will be 
better remembered by all concerned. The 
said fermentation is probably the most 
efficient cause of fatty degeneration that 
clinicians can get at and handle, and which 
indeed they handle now, as it were, in the 
dark. If a more direct statement is asked 
for, it cannot be said why, the circulation 
being impeded by either one or all of the 
causes named, the muscle cell parts with 
its contractile and tensile characters and 
takes on fatty, fragile, untensile and un- 
textile characters, any more than we can 
tell why phosphorus in poisonous doses 
causes the same fatty degeneration of the 
cardiac muscles and death in the extremely 
short space of twenty minutes time, nor 
why the epithelia of the mammary glands 
secrete milk and the hepatic epithelia se- 
crete bile, though both are normal fat 
producers. Here man stands on the con- 
fines of his limits and meets the incompre- 
hensible boundaries of Nature, or rather of 
God, the Creator of Nature. Man can only 
say that these facts are as they are. To 
take a simple illustration: Who can tell 
why gold is yellow and silver white ? You 
say that their nature is to produce vibra- 
tions of light which also produce on us the 
said visual impressions. Any better an- 
swer than the child's " God makes them 
so"? 

I have been using the microscope since 
1850, and Tolles' famous one-fiftieth and 
one-seventy-fifth inch objectives since 1876. 
I have not yet learned the solution of these 
mysteries, though others may; but so long 
as treatment on the lines laid down in this 
clinical contribution has enabled Nature 
to remove fattily degenerated tissues, and 



XIV 

in their place has reproduced normal tis- 
sues, there is a much better basis to work 
on than those now operated for the relief 
of this class of cases. Nature cures fatty- 
ills when causes are removed and she is 
furnished with plenty of dynamis* to work 
with. 



* Dynamis here means virtue or force, inherent, 
actual and potential, or vital energy, sometimes called 
" animal magnetism " for want of a better name. In 
the New Testament dynamis means virtue or inherent 
power to produce effects; ability, authority, efficacy, 
efficiency, energy, might, miracle, right, strength. 
" Metonomically, the Almighty, who possesses power 
and authority." (Greek Testament lexicon.) 



I. 

FATTY DEGENERATIONS THAT ARE NORMAL. 

This chapter may seem out of place, as 
it clashes with the definition; still, normal 
uterine subinvolution and the clinical 
morphology of puerperal discharges beau- 
tifully demonstrate fatty epithelia, oil 
globules, and muscular fibres of uterus, 
large, long, flat, pointed at both ends, and 
undergoing fatty degeneration, whereby 
the organ is reduced to normal in a few 
weeks if health is good. 

There is normal ovarian subinvolution 
in the Graffian follicles or corpora lutea 
of the ovaries after ovulation. 

Epithelial cells of the kidneys, according 
to one author; epithelia of the breasts 
producing fat of milk; epithelia of the 
sebaceous glands; corpora amylacea, or 
amyloid bodies found in the brain, called 
" brain sand," and considered as normal 
by some writers, come under this chapter. 

If the diseases due to old age are nor- 
mal, then, as most of them are fatty ills, 
they are diseases due to normal conditions. 
At least, it is maintained that death from 
old age is a natural death, or that the 
way in which death comes by molecular 
changes when the normal limit of life is 
reached is natural. " The thing that is 
seen is temporal " applies to the animal 
and vegetable kingdoms. Organic life has 
periods of termination to its existence, 
while spirit is "eternal." 

Adipocere, though not a clinical change, 
may be mentioned here. Corpses have 
been known to turn, after burial generally 



for years, into a hard, fat, waxy substance, 
and portions of human muscle have under- 
gone the same change when kept under 
water. Adipocere is regarded as a chemi- 
cal change which certainly prolongs the 
existence of the parts thus changed, and, 
though a degeneration, it is a preservative 
one after death. 

Obesity is an accumulation of fat where 
it naturally belongs in the human body, 
but does not necessarily include the sub- 
stitution of other tissues by fat, though 
the two conditions are sometimes found 
together. Excessive obesity may become 
a fatty ill, and then is amenable to the 
same treatment as the latter. The 
obese, save from the inconvenience of ex- 
cessive bulk, are to be regarded as in a 
normal condition until there is an invasion 
of tissues and organs and these are more 
or less replaced by fat. When obesity and 
fatty degeneration are found together, skill 
in diagnosis is well displayed in deter- 
mining the existence of the latter. The 
two conditions are popularly connected 
together, and generally obesity is thought 
to precede and induce fatty degeneration; 
but the fallacy of this is shown by lean 
people presenting the most typical cases of 
tatty degeneration of tissues and organs. 

The offices of fat in the healthy body 
are too well known to need repeating 
here. They are needful to perfect living; 
but when omental fat accumulates in 
masses as large as a man's hand, it is 
"obesity" and as much a condition of 
disease as it would be to have one's arm 
four feet long. Obesity is amenable to 
diet more than any other means, and does 
not have the proper attention from the 
profession; hence the demand for adver- 
tised nostrums. 



II. 

FATTY ILLS WHICH ARE ABNORMAL AND 
RECOGNIZED AS FATTY DEGENERATION. 

Premature old age. 

Fatty Heart. 

Fatty Liver. 

Fatty Kidneys. 

Fatty Muscles, especially of limbs. 

" Not only do muscular tissues, but also 
"capillary, venous, and arterial vessels, 
" connective fibrous tissues, epithelia, in- 
" tercellular and areolar fat tissues, glandu- 
"lar structures, and even tuberculous 
a lungs, fattily degenerate." * 

A common example is the subcutaneous 
solid fat becoming oils, and in the writer's 
estimate this is an important primal link 
in the chain of evidence necessary to estab- 
lish the diagnosis of fatty ills, of which 
more later. Fatty thyroid glands occur in 
acute diseases. 

" Cancer cells and cells of inflammatory 
" exudation, when their functions have at- 
tained their full development and cease, 
"fattily decay. The flesh and other pro- 
"tein components of one animal, when 
"kept in the peritoneal cavity of another 
"animal, will undergo fatty degenera- 
tion."* 

* Micrographic Dictionary. 

3 



3a 

The fatty degeneration, acute, which 
occurs in phosphorus poisoning, and lately 
noted in a case of death from eating a bad 
oyster, raw, where death ensued in a few 
hours.* 

Probably also in water-gas poisoning. 

* Editorial New York Medical Journal^ 1896. 



III. 

MASQUERADES OF FATTY ILLS. 

The effort is to show that clinicians 
should consider systemic conditions more 
than theoretical names if they wish suc- 
cess to crown their labors. While one 
must respect old names as vehicles of 
thought and information, he must be 
guided so as to remove abnormal condi- 
tions which were unknown when our 
nomenclature of disease was made up. 
At the same time, the medical men of the 
past must not be dishonored, since if they 
"did not know everything, they knew 
something, and knew enough to name 
causes of heart failure, " and who made 
the best use of what they had. Some time 
medicine will be rewritten on these lines, 
for the reason that it is foolish to fritter 
away opportunities of doing good by the 
use of defective " nouns *' that masquerade 
the results of fatty degeneration. 

It is not well to treat disease by names. 
We should treat their essence, unmask all 
physiological sins of their disguises, call 
" a spade, a spade," go for the lesion 
causes, remove them as far as possible and 
give Nature a chance to cure. 

These are so many masquerades of Fatty 
Ills that a brief alphabetical mention of 
them will be made, as follows : 

3b 



Alcoholism is a masquerade of fatty ills. 
A friend suggests King Alcohol wears the 
mantle of fatty degeneration. It certainly is 
a carbohydrate; it certainly makes fatty 
noses, livers, kidneys, hearts, brains, etc.; it 
loads down all the systemic functions when 
used in excess. Alcoholism may be termed 
an acute locomotor ataxia, acute dementia, 
acute softening of the brain, acute idiocy, 
acute mania, acute epilepsy, so much so that 
it seems wise to introduce it here as a mas- 
querader. Again, the alcohol and carbonic acid 
gas found inside the alimentary canal of veg- 
etable eaters are factors in producing fatty 
ills. 

Amaurosis, or partial or total loss of vision, 
from paralysis of the retina; and I presume 
most of my readers would not admit it is a 
masquerade of fatty degeneration. But such 
is a fact, and I do not feel at liberty to leave 
it out, notwithstanding the evidence is not so 
clear as in the other masks; and the convic- 
tion this is true is forced after long con- 
sideration, owing to the fact oculists assert 
amaurosis is mainly due to an excess of car- 
bohydrate diet and that paralysis of the 
retina may be due to, and is part and parcel 
of, fatty degeneration. "According to some 
statistics," says Weir Mitchell, "out of one 
hundred and fifty cases of Bright's disease 
of the kidneys, fifty have retinal complica- 
tions."* 

The complex structure of the eye being of 
terminal tissues where the circulation has to 



*" Diseases of Women," Doctor McNaughton 
Jones, page 82, London, 1890. 



5 
stop and turn back on itself, furnishes facili- 
ties for impeded or retarded circulations and 
renders it easier for paralysis to supervene 
than would be the case if the channels ran 
straighter; indeed the eye is often the first 
organ to suffer from fatty degeneration, as 
oculists have shown. 

Amyloid is a starch-like body or bodies, 
appearing and disappearing in the urine in 
the first stages of Bright's disease. The 
mammae and the liver have at times been 
found to be almost wholly amyloid; the 
same bodies are found in the brain, and 
many imagine they are normal — definite 
evidence that the line of demarcation be- 
tween health and disease is not always clean 
cut. People apparently in good health pre- 
sent signs of latent disease; and so amyloid de- 
generation may come under both conventional 
health and conventional disease; at any rate, 
from the close affiliation of amyloid with 
normal fatty degeneration I think it should 
be regarded as one of the early stages of the 
latter, from a clinical point of view, for I have 
found this estimate safe and useful. Treated 
as a fatty degeneration I have seen amyloid 
yield very readily and permanently disap- 
pear. Note, however, that care must be 
take to distinguish starch grains from amy- 
loid bodies. 

The consensus of all medical opinion, as 
far as known, is that angina pectoris is due 
to calcareous deposits in, or degeneration 
of, the coronary arteries; these deposits are 
of the nature of fatty degeneration of the 
circular muscular fibers of these arteries, and 
are made up of atheromatous matters, mostly 



cholesterine, which attain a hardness like 
stone; hence the term "calcareous." Lime 
deposits also occur along with the purely 
fatty, and their deposition also is probably 
due to the retarded and impeded circulation, 
and to the want of sufficient fluid in the sys- 
tem to keep the lime salts in solution. It is 
easy to see how fatty degeneration of the 
heart substance may follow the partial oblit- 
eration of the coronary arteries. There is 
mechanically retarded function, and likewise 
an element of neuralgia, which may be ex- 
plained by the deposits diminishing the sup- 
ply of nerve force because they partially cut 
off the normal blood-supply, and by a partial 
paralysis of the heart muscles because in 
their ill-fed condition the interval between 
the beats is not sufficient for rest and because 
they thus overwork. Overworked muscles 
are apt to have painful cramps, as in writer's 
and organist's paralysis; hence one cause of 
the choking pain, " angina," in the over- 
worked and ill-fed heart muscles. Again, it 
has been reported, to anticipate a little, when 
facial neuralgia has been relieved by extirpa- 
tion of the Gasserian ganglion or the infra- 
orbital nerve, that the ganglion and nerve 
have been found to be affected with fatty 
degeneration so frequently that this latter 
may be suspected to be a cause of the neu- 
ralgia, and that its treatment should be by 
Nature's own processes of metabolism rather 
than by the surgical changes wrought by the 
knife. I know of one case of surgical inter- 
ference and removal of ganglion for facial 
neuralgia in which the pain returned in ten 
days and persisted until death. Why? 



7 

No surgeon could treat angina pectoris by 
extirpating the cardiac arteries or ganglia, 
but they can treat it through the interstitial 
and profound influences of proper nutrition, 
which obtain and reign in the most hidden, 
profound and vital parts of the body sys- 
temic. In order to give point and force to 
these words, the writer may be allowed to 
state that he has seen cures of this masquer- 
ade performed on these principles. 

Aphasia is a term signifying loss of speech 
— literally dumbness; but medical language 
is flexible and does not mean that altogether, 
and it is employed rather to signify inability 
to use language fluently; it is the loss of a 
perfectly familiar word where the speaker 
knows what should be said but is unable to 
speak it. This in my opinion is nothing but 
a result of fatty degeneration of the nerve- 
ganglia centers in which is located the func- 
tion of speech; and this degeneration is 
undoubtedly acute as well as chronic, while 
both are amenable to treatment by food, 
music, rest, and management. 

Apoplexy is another very common mas- 
querade. The essence of sanguineous apo- 
plexy is when blood escapes from the cerebral 
basilar arteries, and is forced by vascular 
pressure into the substance of the brain or 
into the cerebral ventricles. It forms a clot, 
as blood usually does outside of live arteries, 
veins and capillaries, which clot by its abnor- 
mal pressure paralyzes usually the other side 
of the head or body more or less completely 
— sometimes pressing on the ganglia of the 
pneumogastric nerve and instantly producing 
death; at other times usually entailing a loss 



8 

of consciousness and motion, so that the erect 
subject falls as if struck on the head by a 
club or stone. But the real clinical, essential 
and exciting cause of apoplexy is the rupture 
of an artery by normal blood-pressure. The 
popular idea that apoplexy arises from an 
increased force of circulation has some foun- 
dation, but not the special significance that it 
arisef from a weakening of the arteries by 
changing their substance partly into the flabby, 
soft, weak body of oil, lard, tallow, or grease. 
While it is true that an increased force of 
circulation is a causal element of apoplexy, 
it is truer that the degenerated artery gives 
way under normal heart pressure often during 
sleep, which is usually the quietest part of 
man's existence. To repeat, the essence of 
sanguineous and possibly of the serous apo- 
plexy is a fatty degeneration. In addition, 
some writers state that the brain tissue around 
the diseased arteries is softened probably by 
the same degeneration, which if true only 
makes the claim stronger that this malady is 
a masquerade to be exposed by a better 
nomenclature if possible. The succession of 
apoplectic shocks or fits is explained by suc- 
cessive portions of the arteries becoming 
successively softened by the fatty degenera- 
tion progress, and giving way. It is merely 
a question of time, some parts degenerating 
sooner than others. The rational treatment 
of apoplexy should be directed to the diag- 
nosis and removal of the fatty degeneration 
and the substitution of normal tissues. 

• In retinal apoplexy appear the same caus- 
ative lesions as in cerebral apoplexy: The 
muscular coats of the retinal arteries are 



softened by fatty degeneration in some form, 
and the normal heart pressure ruptures the 
vessels; the ophthalmoscope diagnoses the 
extravasation and the clots in the retinal 
substance. Were the real lesion of retinal 
apoplexy not concealed by its name it would 
be better, for then relief would probably be 
sought in an endeavor to eliminate the pre- 
disposing fatty degeneration. 

Arcus senilis, the senile ring of the cornea, 
is a milky circle about the periphery of the 
cornea of the aged, and should be regarded 
as one of the simpler fatty ills, though it has 
been cited in court as an evidence of insan- 
ity. While it may be found in cases of un- 
sound mind, it frequently occurs in the eyes 
of the perfectly sane. The transparent glassy 
cornea is nourished by inhibition mostly; 
hence there is a difficult circulation and the 
easier occurrence of fatty degeneration when 
the powers of life begin to fail. "Arcus 
senilis" is consistent with health, good or 
otherwise, and is another example of the 
frequent inadequacy of language to express 
an exact condition. 

Atheromatous deposits are masquerades, 
as they "consist of globules of oil of the 
most varied sizes, frequently exceedingly 
minute, mixed with albuminous matter in the 
form of amorphous masses or flakes and 
molecules, plates of cholesterine, and gran- 
ules of carbonate of lime. ,, * They are usually 
found in arteries, especially so in the aorta, 
and take the place of the lining membrane 
and the fibrous and muscular coats. Surely 



* Mlcrographic Dictionary. 



IO 

it is a fatty degeneration, and shows the kin- 
ship of the latter to calcareous degenerations. 
All are due to the same cause, retarded 
circulation by chemical and mechanical 
means. No one who has seen an athero- 
matous aorta can deny that the circulation 
must be retarded and impeded by the marked 
roughness of the interior of the blood-vessel 
that thus becomes a secondary cause. The 
term is derived from a Greek word meaning 
"groats," or meal; and may be applied to 
tumors which from the closure of sebaceous 
glands and the retention of the contents 
accumulate into masses sometimes as large 
as a hen's egg; this latter condition is not so 
much of a masquerade as the term is, when 
applied to arteries; but if the science of lan- 
guage exists to apply to things nouns which 
indicate their nature, then "atheroma" is a 
signal failure in these days of higher criti- 
cism. 

Over forty years ago I was lectured to on 
Bright's disease of the kidneys, and I have 
studied it ever since and cannot but believe 
it is a masquerade of fatty degeneration. 
Its characters are determined by three signs 
which must be present as a general rule in 
the urine, at the same time or in successive 
periods of time, viz., albumen, casts of kid- 
ney tubes, fatty epithelia; besides these, free 
oil, amyloid and catarrhal discharges in the 
urine, apoplexy of the retina, arcus senilis, 
glaucoma and puffy eyelids may be present. 
Rarely is albumen absent; it should be rec- 
ognized as present when the urine becomes 
only slightly hazy from the nitric acid and 
heat test. The idea of this disease being an 



II 

inflammation, chronic or acute, of one of 
more kidney tissues is at least not a good clin- 
ical one. There is a necrosis and breaking 
down of parenchymatous substance some- 
times wonderful to contemplate. Some fifty 
years ago I attended Warren Academy, 
Massachusetts, kept by Mr. A. K. Hatha- 
way, who had Bright's disease. I remember 
well how he had uraemic coma in school 
hours — how he would lean back in his arm- 
chair against the wall, leaving dents in the 
floor which are visible to-day, I believe; how 
he would go to sleep during a recitation; 
how the boys would "catch on" to the situ- 
ation and begin to break rules of order; how 
he would wake up suddenly and reduce 
things to quiet, even if he did shy a Virgil 
or Herodotus at a roguish boy's head! His 
case was treated for twenty years by my 
father, the late Doctor Benjamin Cutter, and 
among other things he used lamp- wick setons 
in the loins with much benefit. After death 
an autopsy revealed both kidneys as empty 
white lardaceous or tallow shells, less than 
one-quarter inch thick — the rest of the kid- 
ney substance was broken down and absent. 
How any one could live with so little kidney 
substance was a wonder to all, but the lesson 
taught was that the lesions were those of 
fatty degeneration, which softened the neph- 
ritic structures so that they broke down and 
disappeared in the urine, leaving the suet- 
like shell as evidence of the wonderful en- 
durance of the human frame. 

When I was a medical student at Harvard, 
Professor G. C. Shattuck spoke at length on 
Bright's disease, and employed exquisitely 



12 

beautiful colored and life-sized French plates 
for illustrations. The gist of his instruction 
was fatty degeneration, but the good doctor 
never gave any clue to really curative treat- 
ment. It seemed to me then, as it does now, 
that the magnificent foreign monographs 
on disease were sadly incomplete. If any 
one doubts that Bright's disease is a fatty 
degeneration resort should be had to the 
morphology of the diseased kidney, and let 
the histological evidence settle the question. 

According to our definition of fatty de- 
generation as due to a retarded and impeded 
circulation, it is easy to see how it can apply 
to the kidneys: The circulation in the pa- 
pillae, the Malpighian tufts, the urinary 
tubules, must be naturally somewhat im- 
peded because of their tortuosity; there is 
constant excretory action and liability to 
overwork; the tubules are deprived of their 
epithelia — filled with casts, albuminous, 
fibrous, or waxy; the cells and tubules are 
loaded with fat globules or with waxy matter 
or amyloid, — all of which make things worse 
by mechanically obstructing the circulation of 
blood and urine. The loss of albumen from 
the blood and the retention of urea tend to 
weaken the system and retard the circulation 
more. 

That paralyzing foods have something or 
much to do with the retarding of the circula- 
tion and keeping up of the fatty degenera- 
tion has been often proved to me, and to 
others, by the results accruing upon the with- 
holding of and substituting a diet that would 
not induce these paralyzing effects — a diet 
that would be assimilated with the minimum 



13 

expenditure of vital force, and yet furnish 
the maximum of potential energy to the sys- 
tem. This history is almost uniformly the 
disappearance in a shorter or longer time of 
the albumen, casts, and fatty epithelia, one 
or all, and by their reappearance when the 
paralyzing foods are eaten again. To be 
sure these results are affected by the way in 
which the patient expends life force. If 
wasted in work, worry, or pleasure of body, 
soul, or mind, the abnormal morphologies 
will be longer in disappearing, or may not 
entirely disappear; or if they have disap- 
peared, under the above losses of vital force 
they will reappear, even if the food is all 
right, and more rapidly if the food is all 
wrong. A cheerful disposition aids the cir- 
culation. 

Acute Bright's disease I have known to 
disappear in less than a week by following 
this line of treatment, but it may require two 
or three years in chronic cases. 

Bright's disease of the lungs is another 
fatty masquerade. Some years ago an emi- 
nent physician asked me to see a patient 
with consumption, who had had the best 
local and metropolitan consultant talent — at 
the rate of six hundred dollars a month for 
the latter; she was in bed, feeble, pale, 
coughing hard, emaciated, with rather vio- 
lent heart action, and night sweats; physical 
signs of lesion of left upper third lung front; 
haemoptysis severe. Sputum with granular 
and crystalline triple phosphates, giant mu- 
cous corpuscles filled with gravel; no lung 
fiber; blood did not show the morphology of 
consumption. Urine, hyaline with fatty casts 



14 

of the kidney tubules and fatty epithelia; 
albumen to one-half the bulk of specimen — 
thus evidencing fatty degeneration of kidneys 
as well as of the lungs, for the blood gave no 
evidence of consumption. On mentioning 
this to the late Doctor Louis Elsberg, he re- 
marked the Germans recognized a Bright's 
disease of the lungs; and he agreed with me 
in diagnosis on this description. Certainly 
there is no good reason why lungs should 
not fattily degenerate as well as any other 
organ, nor why Americans should not adopt 
this form of disease in their nosology; had 
the other medical gentlemen who saw the 
case not been satisfied with the lung lesions 
as a sufficient cause they would have ex- 
plored the urine and got the same striking 
and positive result ! This is a lesson, and 
teaches one should never take a chronic case 
without exploring the morphology and chem- 
istry of the urine; indeed this is a far better 
means of daily testing a case than the study 
of the pulse or temperature. 

Ruptured or broken heart and fatty heart 
are not uncommon. Once I was summoned 
in greatest haste to a lady very ill. She was 
dead before I arrived at her home, and an 
autopsy revealed rupture of the left ventricu- 
lar posterior wall, a pericardium filled with 
blood, and the muscles undergoing fatty de- 
generation. With as good reason as exists 
for cerebral apoplexy this might have been 
called cardiac apoplexy, for there was the 
same giving way of the muscles from fatty 
degeneration, the same extravasation of 
blood, etc., but with death from loss of blood, 
not from its pressure, as in some cases of 






is 

cerebral haemorrhage. When the heart mus- 
cle is fatty it is liable to break at any time 
without unusual effort, as in the case cited. 
The possibility of producing fatty degenera- 
tion in phosphorous poisoning in so brief a 
period as twenty minutes should be remem- 
bered. Possibly phosphorus interferes with 
capillary and interstitial nutritive circula- 
tions, so as to cause degeneration. 

The changes of nutrition in our bodies are 
far more rapid than usually surmised. If the 
chalky, friable textures of dentine can be 
changed to firm normal fibrous texture in 
three months' time (as has been reported), 
why not more rapidly in the softer tissues ? It 
is a remarkable fact, one I have often noted, 
that when cases of fatty heart are treated on 
the principles here laid down, I have seen 
the normal loudness of cardiac pronunciation 
reappear in the course of a few weeks, not to 
say days. Give Nature a chance and she 
will replace fatty cardiac muscles with 
healthy ones ! 

Catalepsy is also, I think, a masquerade, as 
in my experience it frequently presented all 
the signs of fatty degeneration — i.e., oil in the 
blood, fat in leucocytes and albumen, amy- 
loid casts, and fatty epithelia in urine; also 
cystine in the blood, this traced to the eating 
of forbidden yolks of eggs; there was also 
vaginismus, uterine anteflexion and hyperes- 
thesia in one case. The fact that local treat- 
ment — i.e., reposition by uterine sound — with 
vaginal and intra-uterine iodoformization and 
general treatment of fatty ills as here laid 
down, were followed by a cure of catalepsy in 
three months* time and of the abnormal signs 



i5 

in six months, save fatty epithelia which dis- 
appeared months later, certainly justifies the 
mention here of catalepsy as a masquerade 
of fatty degeneration. 

About twenty years ago I consulted some 
eminent Boston oculists as to the cause of 
cataract, and all agreed it is a " degenera- 
tion," though of what kind they knew not. I 
got quite a number of cataractous lenses 
from ophthalmic surgeons, studied their mor- 
phology and photographed them, and with 
the result that I decided it must be due to 
a fatty degeneration. The microphotographs 
I took show it. Later mentioning this fact 
to Baltimore oculists they at once declared our 
German confreres had arrived at the same 
conclusion. Accordingly I think it is safe to 
include cataract among fatty masquerades. 
If it is natural to expect fatty degeneration 
in the cornea — i.e., arcus senilis — much more 
is it to be expected in the crystalline lens 
which obtains its nourishment through its 
capsule by inhibition, and is a hyaline, glassy, 
chitinoid substance to begin with. The dis- 
location of the crystalline lens by a blow 
retards and impedes the circulation needed 
for its nutrition and thus produces traumatic 
fatty degeneration or cataract. The obliter- 
ation of the ocular arteries by the deposit of 
fatty or calcareous matters must impede the 
circulation in the eye and promote the fatty 
degeneration. In London, in 1889, I asked 
Sir Benjamin Ward Richardson whether did 
not both he and Doctor Weir Mitchell, the 
former in 1852, the latter in 1861, produce 
cataract in ten minutes by injecting a tea- 
spoonful of a saturated watery solutioo of 



n 

sugar under the skin of a frog or a guinea- 
pig. He replied in the affirmative, adding 
the result was produced "even quicker than 
that ! " 

It seems incredible that so generally used 
a substance as common white sugar should 
produce cataract in so short a time, but the 
facts are well authenticated and need no 
repetition unless in penal physiology on man. 
Sugar works right in the line of producing 
fatty degeneration in man, and should not I 
think be so recklessly and profusely used as 
now. A teaspoonful of sugar in tea or coffee, 
taken by a case of Bright's disease where the 
morphology of the urine has become normal 
under treatment, must be expected to bring 
back the abnormal morphology; in any event 
this is the way to detect such lapses in diet 
of patients unless they have become firmly 
established in the way of cure. In my opinion 
the defective organs of vision common among 
schoolchildren are due to feeding upon carbo- 
hydrates in excess. Probably the behests of 
social ethics in putting sweets to the fore as 
food have had more to do with the production 
of lenticular troubles than any other cause. 
Avoid the use of sugars in excess (better 
altogether) if you want good crystalline 
lenses. No " sugar trust" to help bring on 
fatty ills for me ! 

Circulation impeded from embolism is an- 
other fatty ill. Thrombi and emboli are 
made up of fibrin filaments which are large 
and massive, in threads curled upon each 
other by rotation and twisting in the circula- 
tion of the blood. Often these emboli em- 
brace within their substance colloid jellies, 



crystals of oxalate of lime, triple phosphates, 
etc., which are formed in the blood. Embo i 
are also made up of white blood-corpuscles 
in addition, their huddling together in the 
blood under the microscope is regarded as 
a sign of embolism (there are emboli of 
fat). 

.The conventional idea that thrombi are 
formed in and on the valves of the heart by 
some action of these same valves is probably 
incorrect; more likely that the edges and 
angles of the valve surfaces present mechan- 
ical arrangements whereby the clots or 
thrombi already formed are caught, incor- 
porated together, and grow; this is rendered 
more feasible because the blood - stream 
makes a full stop at the ventricle funda, 
and is reversed in its direction. During 
the instant of stasis or stopping an oppor- 
tunity is given for the adhesive fibrinous 
masses to be caught on the edges of the 
valves, especially if the valves are sticky. 
The valves do not originate the thrombi 
from the normal subtile, all but invisible, 
fibrin filaments of the blood, but accrete 
them from the larger, coarser and more 
massive abnormal fibrin filaments caused by 
the action of sour fermenting food in the ali- 
mentary canal. 

It is easy to see from the foregoing how 
the circulation is impeded by emboli, and 
how the parts supplied by this impeded cir- 
culation may fattily degenerate; at the same 
time I do not claim that all the results of 
embolism are necessarily the result of fatty 
degeneration, but only that some of them are 
and must be. By taking in this idea can be 



understood the importance of regulating the 
diet in all cases of embolism; and diet and 
embolism together constitute an American 
idea destined to honor the practise of medi- 
cine everywhere and for all time to come, it 
being one of the most important dicta of this 
or any age that embolism can be induced at 
will by feeding fermenting foods, and like- 
wise that embolism can be cured by feeding 
on food that does not have acetic acid fer- 
mentation — food that requires the minimum 
of vital force for Nature to work with in the 
functions of the living human body. In this 
way there will be no growth of excessive 
alcoholic and vinegary ferments, which are 
found associated with thrombosis. It is easy 
to understand how emboli and thrombi arc 
causal of fatty degeneration, because they 
mechanically obstruct, retard and impede the 
functions of all organs whose blood-vessels 
they block up. 

Intestinal concretions, many of them at 
least, are made up of the fat acids accumu- 
lated from the food eaten — the morphology 
of the faeces shows crystalline masses of 
stearine and other fats; also of triple phos- 
phates, uric acid, urate of soda, stellurine, 
sugars, oxalate of lime, cystine, pigment 
matters, etc. Other intestinal concretions 
are calcareous. In the Museum of the Royal 
College of Surgeons, London, there is prob- 
ably the largest collection in the world of 
intestinal concretions, and some weigh sixty 
and even ninety pounds. The close relation 
between fatty and calcareous degenerations 
makes their association in concretions not 
strange. A recent patient produced concre- 



tions from the bowels which had been termed 
11 gall-stones," but as they were always voided 
after the drinking of olive oil, and their struc- 
ture was made up of minute oil globules, 
it was evident they were partially digested 
masses of olive-oil fats. 

When a patient complains of general de- 
bility or general weakness and no sign of 
physical trouble appears but those of fatty 
degeneration in a mild degree, it seems ra- 
tional to regard this lesion as the causal one. 
I have now a case of premature fatty degen- 
eration of this kind. She is a good patient, 
but has an almost incontrovertible opinion 
that nothing will do her good and that she 
will never be any better; not that she objects 
to this on philosophic grounds, or is not rec- 
onciled to the situation. I find as the signs 
of fatty degeneration clear up this mental 
debility clears up also; still I have hard 
work to persuade her to continue in the pre- 
scribed course to replace the norma! tissues. 
Of course general debility has other causes, 
but so long as it masquerades in fatty ills it 
has a place here, and not to be forgotten. 

In a recent case where certain physicians 
signed a certificate that the patient " suffers 
from post-paralytic dementia which would in- 
duce homicidal mania," the probate judge 
was asked to deprive this wealthy man of 
liberty and property; and both these physi- 
cians on oath stated that the man's brains 
were u rotten, Le. 9 softened and decomposed," 
yet gave no clue to the real cause or essence 
of the supposed rottenness. The case was 
compromised. Had it gone on the other side 
would have testified that while there were 



21 

evidences of fatty degeneration in the braifl 
yet there was no dementia nor homicidal 
mania. Admitting dementia, would it not 
have been better to have said that the " rot- 
tenness" came from one of the forms of fatty 
degeneration, as is usually the case — in other 
words, would it not have been wiser to have 
affirmed that the circulation in the brain was 
impeded and retarded by fat metabolism or 
by embolism plugging an artery with fibrin- 
ous concretions, impeding circulation; or 
that the resulting want of proper nutrition 
interfered with the functions of the ganglionic 
nerve centers whereby they would not cere- 
brate normally nor have the capacity for 
normal judgment or reason ? As a matter of 
fact the experts summoned by the defendant, 
who saw him in an unbiased way, could not 
agree wjth the above dictum. The hemiplegia 
of the fight side some twelve years previous, 
which Nature cured spontaneously, and the 
hemiplegia of the leftside in 1887, the urinary 
and blood evidences, were in favor of the 
lesions being due to fatty degeneration. As 
to the idea of homicidal mania following 
hemiplegia, one expert said it was simply 
ridiculous, as the usual course is the other 
way. When it comes to be generally known 
that dementia in many cases is nothing but 
the result of a fatty degeneration and that 
fatty degeneration is curable, new light will 
be thrown on this malady; indeed the treat- 
ment of this case on the plans here advo- 
cated resulted in removing the stigmata of fat 
metabolism, with marked improvement and 
conference of force, so that he survived the 
trials of one of the most terrible adversi- 



22 

ties a sane man can be subjected to. If a 
brain is unsound we must expect unsoundness 
of mind, but it makes all the difference in the 
world if those who treat it do so merely by 
name instead of elucidating the real cause 
under which it masquerades. 

When a case of diphtheria presents albu- 
men, fatty epithelial and casts in the urine, 
while it may not be a masquerade such as I 
have been considering, it comes near enough 
to it to be treated clinically as such, for the 
cure is not complete until the signs of fatty 
degeneration are removed by systemic treat- 
ment. It may be that the poison of diph- 
theria does impede, obstruct and make languid 
functions, and thus becomes a cause of the 
fat ill; but however this may be, clinically 
speaking, the treatment should aim to re- 
move these causes. I venture to predict far 
better results when this principle is utilized. 
It is much better to treat diphtheria before- 
hand by feeding so as to have healthy people 
on whom diphtheria can have no power. 

Strictly speaking dropsy is not a disease 
but a result of obstructed functions, that of 
circulation for one. So long as the profes- 
sion employs the term clinically (and the 
laity think it a most fatal disease, as a rule 
giving up all hope of help on its professional 
announcement) just so long when it is pres- 
ent it must be referred to as a pathological 
entity at the bedside. It is known as oedema, 
anasarca, pleurisy, cardiac effusions, etc., 
acute or chronic according to amount, loca- 
tion, and time. The whole human body is 
wrapped in an environment, outside and in- 
side, of interlaced webs, nets, membranes, 



*3 
and fascia made up of white fibrous tissues, 
straight, wavy, and curling, serving to keep 
the soft parts in place; the interstices form 
areolar spaces mechanically dilatable and 
expansible, capable of distention by air, called 
emphysema; by fat, called obesity; by osmosis 
of blood-serum, called dropsy. From the top 
of the head to the soles of the feet these 
areolae communicate with each other, so that 
puncturing with a knife through the inside 
cheek mucous membrane to beneath the skin 
the subject can inflate the whole body sur- 
face with air; and thus a drowning man could 
make a life-preserver under the skin; more, 
this process has been recommended to pro- 
tect from drowning, though it must be feared 
the application would be impossible or im- 
practicable to say the least ! 

It is well agreed that where there is ob- 
struction to functions, specifically of the 
blood circulation, the sanguineous serum is 
apt to exude and collect in the areolar spaces 
referred to, especially in the lower parts, by 
gravity, and where there is fatty degenera- 
tion. Indeed I cannot recall a case of ascites 
or anasarca where some evidence of fatty 
degeneration was not present, which is not 
strange, considering the fact fatty degenera- 
tion ills come from retarded and impeded 
functions, especially of the vascular system. 
So dropsy and fatty degeneration have the 
same parentage and hence belong to the 
same family. There is no good reason for 
the masquerading of dropsy, especially as it 
frightens people. From the cases of dropsy 
I have seen treated as masquerades of fatty 
ills I feel warranted in formulating the fore- 



2 4 

going conclusions. I have seen cases of 
dropsy recover when, humanly speaking, they 
would have died under conventional treat- 
ment, and thus dying would have given cause 
to the panic of mind that exists in the laity 
when swellings and watery bloats proclaim 
to all around the distention of the areolar 
tissues and great cavities specially described 
by the terrible word " dropsy " 

I am not sure but fatty degeneration 
has a good deal to do with dropsies from 
inflammation, as pleurisy, pericarditis, peri- 
tonitis, synovitis, etc., coming of course from 
obstruction by deposits of coagulated lymph, 
for I have found fatty deposits in pleuritic 
effusion so copious as to line three-fourths 
of an inch deep the chest-walls of the left 
pleura. Also by the plans for treating fatty 
degeneration I have within two months effec- 
tually relieved two cases of chronic fistulous 
pleurisy when it had been proposed to excise 
a portion of the ribs as a last resort. 

The following from the pen of the late 
Professor Joseph Jones, M.D., LL.D., of New 
Orleans,* evidences that vegetable food will 
induce dropsy in the yellow-bellied terrapin 
(Emys serrata), previously carnivorous: 

Starved for four weeks in a tub of water, then 
fed forty-two days on purslane (Portulaca oleracea). 
Blood color intermediate between arterial and ve- 
nous. Serum changed from orange to light yellow. 
Cellular tissues permeated by serum. Abdominal 
and chest cavities contained large amounts of this 



*" Investigation, Chemical and Physiological, 
Relative to Certain American Invertebrata," Smith- 
sonian Contributions to Knowledge. 



25 

serum. Albumen, fatty and extraction matters, 
45.38 in 1000 parts of blood. In another terrapin 
starved for twenty-eight days, and then kept in 
water and on purslane eighty-eight days, weight 
27.125 grains. Serum was light yellow. Two 
fluidounces of serum in pleura and areolar tissue 
along back. Black and brown masses in pancreas 
contained large yellow composite cells, globules. 
The only cause that can be assigned for this degen- 
eration of structure (fatty, crystalline, cancerous) 
is the character of the food. I have never noticed 
this in normal terrapin. 

Other terrapins which had been treated in a 
similar manner were examined, and the results in 
every instance corresponded with those detailed as 
above. 

In most instances the solid constituents of the 
blood were less under a vegetable than under an 
animal diet. 

The intestines are small in carnivorous and large 
in frugivorousChelonians. . . Another marked 
effect in a change of diet was the production of 
dropsical effusions. 

Vegetable food in excess then is a chief 
cause in producing dropsies and fatty ills in 
man. 

All the cases of epilepsy I have studied 
have presented the stigmata of fatty degen- 
eration at different periods of time, but not 
all together. Dr. M. G. Wheeler of Chelsea, 
Massachusetts, tells me that he never had a 
case of epilepsy without albumen in the urine! 
Now while albumen alone does not complete 
a diagnosis it makes it very probable that a 
careful morphological study would have sup- 
plied the missing links of diagnosis of fatty 
degeneration. Again the disappearance of 
all the signs of fatty degeneration has been 
followed by the cure of epilepsy, or to put it 



26 

differently, the epilepsy was not cured before 
the said signs disappeared; it is probable 
that they had something causal to do with 
the cases. At any rate they are good enough 
clinical clues to unmask a masquerade. 

Since gall-stones are made up of choles- 
terine, a fat acid, they come within the same 
scope. Cholesterine is a normal product of 
the liver, and should flow off in solution into 
the small intestines; but when it accumulates 
in crystalline masses enough to clog the gall- 
bladder, not to say the gall, mechanical ob- 
struction is formed to the circulation of bile 
as well as of blood. Gall-stones must thus 
cause the fatty degeneration of the gall- 
bladder which cholecystotomists report as a 
great trouble in their operations, but this is 
rather a result than a cause. The cause lies 
deeper in the same kind of food referred to 
above and also in not having water enough 
in the system to keep the saline bodies and 
fats in solution. Hot water is one of the best 
promoters of intestinal secretion; it keeps the 
liver well washed out, removes the gases 
from fermenting food which paralyze the ali- 
mentary canal and abdominal viscera. Thick 
liquids flow less quickly than thin. If, for 
example, when the bile is inspissated and 
thickened so that the gall-stones crystallize 
out, as salt does from watery solution when 
the water is evaporated, one way to relieve 
this is to use plenty of distiiied water, which 
contains no salts and which will thin the bile. 
Indeed, calculi or gravel of the blood, urine, 
salivary glands, intestines and other parts 
may all be rationally treated on the plans of 
quickening a retarded circulation by the use 



27 

of hot water. In the words of Doctor A. H. 
Ferguson, of Chicago:* 

Let the physician who is in the habit of saying 
to his patients suffering attack upon attack, " Oh, it 
is only gall-stone colic," study these changes and 
then apply the postponement of seeking surgical 
relief to his own person ! 

The Golden Rule is aptly befitting. 

Can the milder forms of cholelithiasis be cured 
wj^out the knife? 

? Why not ? Why does this fatty excremen- 
titious substance (cholesterine) not go on to 
its stercoraceous transformation and not form 
stones in the biliary system of ducts ? Is it a 
conservative act on the part of Nature to 
prevent absorption of the constituents of the 
bile in catarrhal and obstructive conditions of 
these ducts ? 

What is the relationship of cholelithiasis and 
gouty and uric acid diathesis? 

Not water enough. 

What local or blood changes predispose to their 
formation ? 

Retardation and impeded motion for want 
of liquidity. 

What diet, medicine, or hygienic surroundings 
might prevent them? 

Beef broiled or roasted and hot water, 
and medicine sparingly as indicated. 

Solve that question and the surgeon's knife, needle, 
or button will happily be less in demand. 

Belter solve it with distilled water 



* The Journal of the American Medical Au^cuh 

Hon, January 19th, 1895. 



23 

Experimental researches in these directions are 
very enticing and should bring forth most bene- 
ficial results. 

They have already been made, and this 
whole paper is a reply. 

Probably never was the term " heart fail- 
ure" more popular than now, yet it really 
means little in itself, for death by a bullet 
through the heart is " heart failure;" or, if 
the heart were so embarrassed with fibrinous 
concretions and valvular lesions as to stop, it 
still would be " heart failure." The title ex- 
presses a result, not a lesion or a cause. But 
it is used as a cause, and must be accepted 
so long as it is used clinically, however much 
one may dislike its not representing actual 
conditions or history. 

From the fact that so many people live on 
food which is calculated to give fatty degen- 
eration by impeding the circulation, not only 
may the heart fail because it cannot over- 
come the obstacle, while it tries hard to do 
so, but in most cases it probably is itself 
weakened by the substitution of fat in place 
of its muscular tissues. The fat sometimes 
found in and around the heart, if it does not 
replace other tissues save by pressing on 
them, is not to be regarded as a fatty ill, but 
rather as obesity. 

In my opinion in many of the cases of 
so-called conventional " heart failure" the 
failure is due not only to the fatty ill but 
to the direct paralyzing influence of the 
stomachic and intestinal gases acting on a 
previously weakened or fatty heart. Secre- 
tary Windom's death at a Delmonico banquet 
during an after-dinner speech may have been 



2 9 

one of these cases. So far as I could learn 
he had symptoms of fatty degeneration be- 
fore he had eaten this dinner — he used his 
forces to make a speech before the food was 
digested; he took away force from its work 
of digesting food, the stomachic gases acted 
by osmose, paralyzed the heart, and it failed. 
Such an accumulation of gases in the stomach 
is common at two or three o'clock in the 
morning. Doctor J. Marion Sims and others 
have died of " heart failure " at about this 
hour and probably from gas accumulation 
acting on the heart as just noted. Could 
draughts of hot water (which have wonderful 
effect in causing stomachic and intestinal 
muscular contractions and by starting the 
"wind") be freely imbibed many of these 
cases could probably be saved by thus re- 
moving the immediate cause. Cold water 
will also expel gas, but not nearly so readily. 
It is more probable that the heart would not 
succumb to this depressing influence were it 
not itself more or less fattily degenerated. 
Both Secretary Windom and Doctor Sims 
were at a time of life to have fatty ills. I 
know Doctor Sims ate things that would pro- 
duce fatty ills. Striking his breast he once 
replied to my remonstrances, " I can eat any- 
thing," So also died that great physician 
Doctor Louis Elsberg, after I had relieved 
him of all signs of fatty degeneration, mas- 
querading as Bright's disease of the kidneys, 
he acknowledged his cure but insisted upon 
eating what he liked So also died another 
friend lately of fatty degeneration though he 
asked for but would not receive the gospel ot 
food salvation from his fatty ills. He said, "1 



3Q 

am in the best hospital in the world," yet they 
gave him the very things to eat which kept 
his heart fattily enlarged and weakened. 

Why should fatty heart masquerade as 
"heart failure?" Why not come out and 
make names as chemistry and commerce 
name things? By special invitation Doctor 
Da Costa lately gave a lecture on weak hearts 
to the Medical Department of the University 
of Pennsylvania, at which the Provost, Doc- 
tor Pepper, and other dignitaries were pres- 
ent in honor of the occasion. In this lecture 
the diagnosis of fatty degeneration was based 
on "elderly gouty subjects, rigid arteries, and 
flabby tissues, with breathlessness on slight 
effort, as going up ascents.'' 

The moment that it is conventionally un- 
derstood that fatty ills are at the bottom of 
heart failure, that moment will there be a 
chance for more rational treatment. This 
is said notwithstanding Doctor Da Costa's 
dictum that "in the fatty heart the disease 
may be palliated, but in the end it is fatal" 
I speak from personal experience. 

Now regarding deaths from heat. The 
New York Tribune of August 14th, 1896, re- 
ported a policeman found dead. Foul play 
was feared, but an autopsy showed that 

Death was due to heat, to which ... he 
was especially susceptible on account of fatty de- 
generation of the heart. ... He was fifty-three 
years old About four months ago he had a slight 
stroke of paralysis and a fall. . . There were 

charges pending against him at police headquarters 
for having been found asleep . . . when he 
should have been on duty 

In the same issue there is an account of 
the sudden death of Henry Van Deremde 



3* 

apothecary manager, found dead by a clerk, 
who in two hours after was himself found 
unconscious. The death and the prostra- 
tion were due to the excessive heat. A 
policeman found the clerk lying insensible 
on the floor by the side of the dead body he 
sat to watch. The coroner and the examin- 
ing physicians certified that death was from 
apoplexy superinduced by heat. This puts 
the case on record as a fatty ill. 

In the other case the paralysis and im- 
proper sleep, with the condition of the heart, 
suffice for the same diagnosis. 

It is a question, If they had been perfectly 
healthy would the heat have killed them ? I 
trow not. Their bodies were rotten with fat 
metabolism; they succumbed as a decayed 
post is easily overturned by a blow. There 
is no doubt that the heat was sudden and ex- 
cessive. It has been said that more deaths 
of men and animals were reported in New 
York during this heated term than ever be- 
fore. Horses died by the hundreds. 

If the cases were all like these reported 
here, then they were masquerades. People 
eat largely of carbohydrates during hot 
weather, because they think animal food un- 
seasonable, a conclusion I doubt. Carbo- 
hydrates burn up and make heat; ice cream 
is good to produce warmth; salads easily fer- 
ment. Lean meats broiled or roasted build 
up the entire body and give energy to replace 
the tremendous waste of salts carried off in 
the greatly increased sweat action. Again, 
outside of the loss of force by sweating peo- 
ple are directly prostrated by the action of 
the excessive heat on the nerve centers. The 



32 

practise of the writer and corroborator has 
been to prescribe lean meats broiled or 
roasted, with boiled potato or toasted bread 
or rice; no ice water, but cool drinks if de- 
sired; but hot water quenches thirst best of 
all things. 

Hebetude or listlessness and slow move- 
ments I have seen in fatty ills. One patient 
who had Bright's disease and was a multi- 
millionaire said he was so lazy and slow- 
going that he thought of hiring a man to go 
behind him and apply a horsewhip when he 
lagged. This case was entirely relieved of 
the signs of fatty degeneration, when he said 
he could " run " his own case, and he did — 
"run it under ground " in less than two 
months. 

I have great sympathy for lazy people. 
Often if some patients could be lazy they 
would get well faster, but as I grow older I 
am more and more convinced that the hebe- 
tude and laziness in question might be traced 
to fatty ills, because the sufferers have no 
reserve power, soon fag out, and are listless 
for very good reasons— /.*?., the loss of muscle 
fibers and nerve force from interstitial substi- 
tution of fat for the nervous and muscular 
tissues. 

Haematophilia is another masquerade of 
fatty degeneration, as is any form of bleeding 
or haemorrhage due to rottenness of blood- 
vessels of the capillary and venous kind, 
which rottenness arises from a substitution of 
lardaceous, waxy, or steatomatous elements. 
It may be said also that where the extraction 
of a tooth threatens life because of profuse 
haemorrhage, it comes under this head. 



33 

Hemiplegia, or palsy of one -half of the 
body, is a common masquerade of fatty de- 
generation of the muscular coat of the basilar 
arteries, as before explained. The pressure 
made by the extravasated blood on the cer- 
ebral substance exerts by decussation a par- 
alysis on the opposite side of the body, and 
sometimes of the same side of the body. It 
is associated with apoplexy, and is mentioned 
here by itself because the name is used by 
the bedside clinically, and is generally re- 
garded in clinical medicine as a disease by 
itself. The severity and persistence depend 
on the topical character of the effusion, as 
copious or limited in extent. 

The treatment of hemiplegia rationally 
comes under the head of fatty degeneration, 
as I have taught for many years. It is unwise 
to expect cures while causes go on at work 
just the same as before the treatment. 

Hyperaesthesia, again, is another general 
masquerade. The following case is adduced 
in evidence: 

December 30th, 1894, a dentist of New 
York died at the age of about 71 years; had 
been ill for more than four years. His blood 
at the outset had shown oil from beneath 
skin, and fat in the white corpuscles. Albu- 
men, fatty epithelia, and kidney casts were 
occasionally found in the urine, singly and 
together. When free from albumen, casts, 
and fatty epithelia, catarrhal discharges 
would be present in the urine. At times the 
urine would be normal. It should be said 
that this urine was carefully studied by me 
daily for months. By partial treatment the 
abnormal forms and albumen were mostly 
removed, and there was an improvement in 
health, 



34 

Two and one-half years later he had in the 
right side of his neck a large chronic diffu- 
sive abscess which dissected in between the 
muscles and fascia below the mastoid proc- 
ess, and afterwards apparently healed. Then 
the right lymphatic and submaxillary glands 
became involved The parts under and at 
the right angle of the lower jaw were swelled, 
thickened, and hardened. The aspect was 
so malignant that after aspirating and ob- 
taining naught but blood a doctor of New 
York pronounced it cancer. This opinion 
was sustained by the terrible hyperesthesia 
of the mouth, tongue, and throat; by a ca- 
tarrh of the parotid and salivary glands, 
which was constant, copious, and agonizing; 
by cachectic appearance; by emaciation; and 
by this distinguished surgeon's large experi 
ence with cancerous submaxillary glands, he 
having extirpated over two hundred. To be 
sure, crenated pus without cancer-cells was 
found a few days after over the site of aspi- 
rated puncture. 

Later the doctor, in my presence, aspirated 
thoroughly again. The needles brought 
forth a bloody fluid, which microscopically 
showed oil in large and small globules, curling 
fibrous tissue resembling lung tissue found in 
sputum, free red and white corpuscles, and 
fibrin filaments massed in threads and clots. 

This would appear to have been a fatty ill 
from the fact that the two aspirations were 
followed by no malignant changes; that the 
dense lymphatic swelling would diminish and 
increase from time to time; that there was 
never any unpleasant odor; that there was no 
previous history of cancer; that there was 
unmistakable evidence of fatty degeneration 
for years before; that the lymphatic glands 
could have been inflamed from the dissecting 
cervical adjacent abscess, as in other cervi- 



3S 
cal abscess histories; that save redness and 
hyperesthesia the oral cavity and pharynx 
were normal; that the tongue was soft as silk 
and its glands were free from induration; 
that the hyperesthesia was beyond all evi- 
dence visible to careful inspection; that the 
gentlest touch of his whiskers, nose, forehead, 
site of diseased glands, indeed all over the 
body (he could not bear to have vaselin 
rubbed on his feet or toes), caused agonizing 
subjective pains; that he persisted in assert- 
ing that it was agony for him to swallow 
(dysphagia) anything, to move his jaw, to 
speak, etc. From these things the writer 
could not concur in the diagnosis of cancer, 
but said that in his opinion it was a case of 
lymphadenitis with fatty degeneration, in- 
cluding hyperaesthesia and hypersecretion of 
the salivary glands. 

The morphology of the oral discharge, 
studied very often, showed mucous corpus- 
cles, bacteria, pavement epithelia, red blood- 
corpuscles, white blood-corpuscles often with 
red blood-corpuscles inside of varying sizes, 
that appeared to come from the diseased 
lymphatic glands, which I regard as red 
blood-corpuscle makers — Leptoihrix buccalis, 
— crystals of the triple phosphate of lime, 
magnesia and soda, and the aniline blue and 
emerald green pigment matters that are 
found in connection with fatty degeneration 
in the blood especially along with portal ob- 
struction. 

The hyperaesthesia was as bad as any 
uterine hyperaesthesia I ever saw, and this is 
saying a good deal; it was the great and 
most prominent symptom in the case. At 



36 

first I attributed it to the rare overaction of 
the salivary glands, that weakened them and 
then translated their neurasthenia to all other 
parts, as is seen in cases of nervous prostra- 
tion of uterine origin for example. As fur- 
ther evidence that this case was a masquerade 
of fatty degeneration I may add an autopsy 
revealed the right angle of the jaw standing 
out and away from the tumors as if there 
were no tumors; the hardened subdermal 
lymphatic gland was only half an inch in 
diameter, cut with a slight grit, under micro- 
scope showed white fibrous tissue straight 
and curled, some granules of fat, no elements 
of cancer form — indeed such had never been 
found in this case by me. The submaxillary 
gland appeared like a fatty kidney, somewhat 
dense in feel to the knife. Under the micro- 
scope the glandular epithelia were found 
filled with fat in large and small globes and 
in granules much the same as the fluid ob- 
tained by the second aspiration presented; 
besides, the stroma or parenchyma of the 
gland was studded with immobile fat gran- 
ules, while the fluid fat granules presented 
automobile movements such as are seen in 
milk. The glandular structure was homo- 
geneous, save this heterologous tissue. The 
cells appeared like liver-cells secreting fat. 
The gland was evidently fattily, not cancer- 
ously, degenerated. The forefingers of both 
hands successively introduced through an 
opening made at the right angle of the lower 
jaw fully explored the pharynx and base of 
tongue. No enlarged lingual glands nor 
lingual induration were found. The larynx 
was felt to be normal. Arytenoid cartilages, 



37 

epiglottis, and glottis unaltered. Vomer and 
nares normal, dome of pharynx normal. The 
interarytenoid band and the anterior wall of 
the mouth of the oesophagus were not thick- 
ened nor abnormally changed. Doctor John 
A. Cutter verified the examination, and had 
the case been cancerous the exploration 
should have shown it. 

But the question is, how can this terrible 
hypersesthesia be explained better than by 
considering it not at all as coming from can- 
cer ? Cancer does not usually cause pain 
away from the site, all over the body, nor 
affect the whole body so that the slightest 
touch, the gentlest feeling of the pulse at the 
wrist, causes the severest pain. Should it not 
rather be considered as a masquerade of fatty 
degeneration, like angina pectoris and tic 
douloureux? Surely fatty degeneration was 
the most constant and prominent element in 
this case. The patient never fully followed 
out the treatment for fatty ills: would not 
live on broiled chopped beef alone; refused 
nutritive enemata. He refused to eat because 
of the agony of swallowing and increase of 
saliva. He complained of choking while eat 
ing, but never choked nor regurgitated food 
through the nose or mouth, as is usually the 
case in stenosis of the throat. His mind was 
very much on the alert; he noticed all that 
was going on, as conversation, deeds, ques- 
tions of domestic ethics, etc. He got but 
little sleep without medicine — quarter-grain 
doses of codeia sufficed, and lactucarium 
served for a time. Towards the last the ab- 
normal lymphatic and salivary secretions 
ceased to flow Refusing to eat he died of 



38 

starvation. Could he have fed like other 
cases he ought to have got better. 

At one time my mind was made up to cut 
through the diseased gland for diagnosis and 
local stimulation, but was deterred by the 
opinion he held that it would increase the 
disease to extirpate it. Had either been done 
I think it would have proved good for both 
patient and operator. However, so long as 
the patient would not come down to strict 
business in the alimentation needful to re- 
place fattily degenerated tissues there is no 
doubt that the fatty ill would have progressed 
to a deferred death. 

■This idea of some neuralgias and hyper- 
esthesias being due to fatty ills opens a new 
door to efforts for relief of pain by means of 
food mainly. 

Insanity sometimes figures as a cause when 
it is only a result of fatty degeneration in the 
cerebrum from retarded and impeded circu- 
lation, or from embolism. It is not insisted 
that these alone are causal, but that they 
sometimes cause insanity — a very broad term, 
which in law covers all its varieties. Insan- 
ity from fatty degeneration is evidenced by 
imbecility, arcus senilis, fluid fat in the blood 
from beneath the skin, occasional or constant 
fatty epithelia, casts of the kidney tubes, and 
albumen. It also may be recognized in ad- 
dition by the ophthalmoscope revealing fatty 
changes in the eyeball. Insanity from this 
cause should be reckoned as a masquerade 
of fatty ills, since its cause may be unwit- 
tingly kept at work by food which, thought 
to be the most wholesome, produces the ills 
it is designed to evade. 



39 
One of the most learned and successful 
physicians, said to have a larger income from 
his profession than any other American, told 
another medical man that he diagnosed loco- 
motor ataxia from the fatty degeneration in 
the white blood-corpuscles as well as by the 
rottenness of the red blood-corpuscles, which 
comes between the rottenness of the red 
blood-corpuscles of rheumatism and con- 
sumption. In 1892 I had a case of locomotor 
ataxia when at one time locomotion was im- 
possible without help. While it was being re- 
gained the right arm would be lowered by the 
torsion of the trunk, so that the hand would 
nearly come to the ground. Several other 
physicians saw the case, and all coincided in 
the diagnosis, and excepting myself made a 
fatal prognosis. The man was then about 
thirty years old, and suffered terribly with 
pains. He was put on strict diet, and after 
much tribulation was restored to health, so 
far as locomotion and the common duties of 
life are concerned, but his handwriting is 
still ataxic. This case is mentioned because 
I think I ought to have detected the pre- 
locomotor ataxic state in him. I did find the 
fat in leucocytes occasionally, albumen in 
urine, casts occasionally, and fatty epithelia, 
and I was on the lookout for kidney destruc- 
tion. The essence of locomotor ataxia seems 
to be in a thickening of the fibrous sheaths 
of the spinal nerves, as well as a degenera- 
tion of the spinal cord itself. I must say 
that the fibroid and fatty degenerations are 
very closely akin; clinically they are alike, 
to be cured by Nature's being given plenty 
of force to work with, and mostly by stop- 



40 

ping causes— to wit, fats and carbohydrates 
in too great excess. 

Melancholia means "black bile," which the 
ar lents recognized as a symptom of a form 
of insanity, and perhaps truly. Black bile 
is apt to be inspissated; and thus retarded 
and impeded in circulation it will take but 
little to make the normal fatty cells of the 
liver, complex in its anatomical structure and 
physiological functions, run over into fatty 
degeneration — that is, if our definition is 
correct. The relation of liver troubles to 
the condition of the nervous system is very 
close and depressing, as instanced in the sec- 
tion on general debility: one reason is, if we 
consider life to be a question of expenditure 
of vital force, that it must take more force to 
run the liver when its circulation is sluggish 
and difficult; then this abstraction of force 
takes from the other organs — the brain for 
example, — and the outcome is, there is not 
force left to run the brain properly. From 
all this follows the depression of the nerve 
centers called melancholia. Of course the 
science of language, notwithstanding the 
higher critics, is imperfect, and other causes 
may exist for melancholia; but not being in 
position to rewrite the English language one 
must be content with nomenclature as it is, 
and satisfied with this little hint to try to 
show the way in which the thought of those 
who come in contact with this presentation 
may properly employ their investigations. 
Look out for fatty degeneration in melan- 
cholia! 

Neurasthenia is a term used to denote a 
nervous prostration whose origin is unknown 



At 

or obscure, and from what has been said it 
may be inferred that fatty degeneration may 
be a cause; indeed I am convinced I have 
seen neurasthenic cases of fatty degeneration, 
and that there is always a cause for neuras- 
thenia, discovered or not. The kinship of 
male neurasthenia that arises from a peculiar 
urinary catarrh, which often disappears and 
is replaced by fatty epithelia, casts of kidney 
tubes, and albumen in the urine (one or 
both), is I think very close, and makes it 
proper for neurasthenia to be classed as 
sometimes a masquerade of fatty degenera- 
tion. At any rate it is worth studying in this 
practical connection. 

Paraplegia is a variety of hemorrhagic 
apoplexy where both sides of the body lose 
their motor, and sometimes sensory, func- 
tions because of the greatness of the pres- 
sure on the brain; it is mentioned because it 
is a masquerade of fatty degeneration not to 
be overlooked. It is due to a more extensive 
rupture of the cerebral arteries than usual, 
because the normal strength of these arteries 
has been weakened through the substitution 
of muscular and sometimes fibrous tissues by 
oleic acid, palmitic acid, and cholesterine, etc., 
which substances have no textile strength 
to resist centrifugal forces as they do centri- 
petal forces when blood is forced and buried 
in the outside soft cerebral parenchyma. 
Paraplegia is mostly a question of strength 
of structural elements whose nature is softer 
than normal. From this point of view it is 
wonderful paraplegia does not oftener occur. 

Paresis means general paralysis of motion 
(and not of sensation), more or less complete; 



4* 

if complete there would be no paresis, be- 
cause death would at once follow from heart 
paralysis. It is rather a paralysis resulting 
from the degeneration of the tissues of the 
body, not confined to the muscles, but em- 
bracing the structural elements of the nerves, 
fibrous tissues, etc. It is most likely to be 
fatty in some one or more of its forms. 
There are partial responses to stimuli of the 
sensory or motor nerves, but there is also a 
relaxation which shows that the neurotic sys- 
tem is paretic. Instead of masquerading as 
a separate disease it should appear as only 
one of the manifestations of fatty ills which 
demand an interstitial nutritive treatment 
whereby Nature can and will restore the de- 
generation, entirely remove the fat intruders, 
and thus cure on common-sense principles. 

Pernicious anaemia is believed in America 
to arise from terminal arterial vessels fattily 
degenerated, leading to a pernicious loss of 
blood discs so grave and severe as to be 
fatal. The main points are: It usually occurs 
in the last stages of fatty ills: Both voluntary 
and involuntary muscles are involved: The 
parent cells in the blood-glands are degen- 
erated: Blood is not organized in normal 
quantities: Patients grow bloodless and 
weakened. The treatment should be that of 
the fatty ills. 

After more than thirty years of considera- 
tion, puerperal convulsions seem to me to be 
due to an acute fatty degeneration of the 
kidneys, placenta, etc. I am well aware that 
others do not entertain this view, but how 
can one read the signs and symptoms other- 
Wise? Let me relate a case: 



43 

In 1880 a young wife was pregnant with 
her first child. At her marriage I met her; 
she was then thin, slim, apparently well. I 
saw little of her before she was far advanced 
in pregnancy, when her appearance was so 
changed that I hardly knew her; a lady very 
stout, obese, and bloated, with eyelids (Ede- 
matous and face waxy. She made little 
complaint. She had lived a life of no work, 
eating all the "good things" she could find, 
boarding with her mother and having an easy 
time. The urine contained plenty of hyaline 
and fatty cylinders from the kidney-tubules, 
abundant fatty and deformed epithelia, and 
was two-thirds in bulk albuminous. I gave 
her simple remedies and arranged for sum- 
mons when her labor should begin. It hap- 
pened that night. She got through well. The 
babe weighed three and one-half pounds. 
The placenta was one-third degenerated into 
what appeared to be ovoid and obovoid 
masses, possibly syphilitic or cancerous even. 
I had not met with such appearances before, 
nor have I since. The clinical morphology 
of the placenta showed the whitish, hard 
masses to be made up of plates of cholester- 
ine, as a rule longitudinally parallel with the 
long axis of the placental tufts. When the 
babe was one day old, and the mother doing 
well, a steam fire-engine, for practise, was 
attached to a hydrant in front of the house 
where she was and set going in spite of the 
protestations of those concerned in the care 
of this patient. The shrill sound of the whistle 
blown in defiance sent her into convulsions, 
which lasted eighteen hours, consciousness 
not returning until two days later. She was 
treated by ether ancesthesia, calomel and 
jalap purging, and beef essence ad libitum, 
combined with very careful watching^ and 
nursing. In less than one week the albumen 
and the casts disappeared, and she gradually 
convalesced into a good recovery, though the 



44 

left side of the face was paralyzed for some 
months afterwards. At the present time there 
is a slight facial paralysis. Otherwise she has 
developed into a woman of splendid capaci- 
ties and mental abilities. 

To show that Bright's disease of the kid- 
neys has convulsions as a symptom I can refer 
to a case of a man who also came near dying 
in like convulsions, but survived some months 
without convulsions on the diet which is em- 
ployed to arrest fatty degeneration. No 
doubt there was ursemic poisoning in these 
cases; still the essence of the disease was 
the fatty degeneration, as manifested by the 
physical exploration. How can the kidneys 
properly eliminate urea when they are choked 
and impeded by fatty metabolism ? 

If motherhood would feed on two-thirds 
animal and one-third vegetable food by bulk 
I think there would never be any puerperal 
convulsions from fatty degeneration. This 
is said advisedly, as in the case alluded to 
two other children were born afterward to 
the same mother living on this diet; no 
puerperal fatty ills complicated these second 
and third labors. 

Those who saw the frozen sections of 
pregnant women's trunks, and witnessed the 
enormous abdominal distention and the great 
displacements of the thoracic and ventral 
viscera, at Berlin Medical Congress in 1890, 
cannot but believe that the circulations are 
hampered and impeded Thus is furnished 
one of the great prerequisites for tatty de- 
generation. The wonder is it does not occur 
oftener, when so many women live to eat, not 
eat to live. 



45 

The case cited had insufficient exercise, 
which it will be remembered is enough to 
spoil even horses in a few months by the 
degeneration in question. 

Albuminuric retinitis is a form of fatty 
degeneration. Lately I was shocked to learn 
from a most eminent American maker of 
telescopes that his wife, whom I had met 
apparently well a year or two previous, had 
died of Bright's disease of the kidneys. This 
was undiscovered until just before death, 
though her medical attendants (he said) had 
repeatedly examined the urine and found no 
albumen. — I wonder if they looked for fatty 
epithelia or cylinders. The detection was 
made by the ophthalmoscopist. Here is a 
lesson for the profession ! For this want of 
diagnosis the bereaved husband was so bitter 
on medical men that I thought he meant me 
in particular; so I furnished him with evi- 
dence such as I am giving here to show that 
the medical profession was not at the low 
level he claimed. I did not assert that other 
medical men knew less than myself, but I 
did insist that some medical men knew how 
to detect and treat the disease in question, 
and that I would not calmly submit to his 
unsustained assertions. In evidence let me 
quote from the Medical Times and Register* 
as to retinitis being a fatty degeneration: 

(Edema of the lower eyelid; the upper has a less 
lax histological structure, — a very characteristic 
symptom of Bright's disease: 

Dim vision with fading and receding pupil from 
iris muscles being weak: 



* February 24th, 1894, 



46 

Pupils dilated from weak iris muscles: 

Michael says that cataract and albuminuria are 
simultaneous results in the eyes and kidneys from 
the same general cause — arterio-sclerosis.* 

Doctor L. Webster Fox says: "We have the 
forerunner of non-albuminous Bright's disease in 
retinal haemorrhage; there is sclerosis of blood- 
vessels as shown by whiteness:" Also says, "The 
capillaries are involved in like changes: Signs of 
albuminuria retinitis; optic nerve swollen, vascular 
walls about blood-vessels more or less white." 

Forster thinks the disease is due to alteration of 
the blood which causes degeneration (fatty) on the 
blood-vessels' walls. f Charles Theodore, Duke of 
Bavaria, found hyaline (fatty) degeneration and 
endoarteritis in retinal arteries. The middle and 
internal coats are thickened, and the caliber less- 
ened (i.e., circulation impeded); small fatty gran- 
ulations sometimes filled the small arteries. 

Fibers of Miller late in disease show traces of 
fatty degeneration, and are full of granulation or 
small drops of fat. 

From what has been said it can be readily 
seen that rupture of muscle is a masquerade 
of fatty metabolism. Fat may replace mus- 
cular fiber from high feeding without due 
exercise; from ligatures about said muscles; 
from the circulation being impeded by the 
gases of fermentation in the alimentary canal. 
It is easy to see how such weakened muscles 
may rupture from violent efforts; but muscles 
may rupture while doing life's legitimate nor- 
mal work, — in other words, muscles may be so 
weakened in substance as to tear themselves 
apart in normal efforts. It is easy to see 
how powerful muscular force ruptures the 
muscles themselves, even when they are not 



*I add, which is due to food.— E. C. 
t Wrong.— E. C. 



47 

fattily degenerated, as in the case of our 
Saviour at his crucifixion. He was in per- 
fect health, yet medical men who have 
critically studied the immediate cause of his 
death are well satisfied that his heart was 
literally ruptured by anguish. Christ's death 
being so much earlier than ordinary in cruci- 
fixion caused Pilate to wonder why he died 
so soon. 

Rupture of uterus might come under rup- 
ture of muscles, but as it constitutes one of 
the gravest accidents of obstetrics it deserves 
a separate mention. The following were the 
prominent features in a case of mine: 

Irish woman aged 28 years; pelvis con- 
tracted; previous labor, one, terminated after 
several days by Doctor Benjamin Cutter by 
embryulcia. In i860, July 7th, 9 p.m., I 
found her with strong pains; os fully dilated; 
occiput to the right acetabulum; head in 
superior strait whose anteroposterior diam- 
eter was about three inches. For several 
hours the labor was severe; no headway. 
Forceps refused at first; but just as they 
were about to be resorted to she urged man- 
ual help. Passing hand still further, to my 
horror I found a free and open space in 
which were felt folds of the peritoneal sur- 
faces, the wedge shape of the liver, the feet 
and hands of the child, the placenta, etc. 
The uterus was firmly contracted and lying 
to one side. It was the first time my hand 
was ever inside the abdominal cavity of a 
living human being ! 

Things were so critical that I at once 
turned and delivered by the feet. I asked 
for assistance, but the patient and friends 
insisted on my carrying the case through 
alone. 



48 

After delivery the patient had a pinched 
face and Hippocratic countenance; no pulse 
in wrists; extremities cold; sighing respira- 
tion; great distress in abdomen. Was con- 
stantly begging and entreating to be allowed 
to sit up. Great restlessness, constant vomit- 
ting, and intense thirst. Freely gave tincture 
of capsicum, ergot, Hoffman's anodyne, gin, 
and tincture of opium. From these some im- 
pression was made on the pulse and symp- 
toms. Abdomen very tender to the touch and 
very painful to patient. Death followed 
twenty-nine hours after delivery. The rup- 
ture involved the lower part of the uterus and 
the upper part of the vagina, posteriorly. 

Fortunately, this condition is exceedingly 
rare; the case is here given as a necessary 
clinical contribution. 

If I could control the diet of obstetrical 
cases, it would be two-thirds animal and one- 
third vegetable food by bulk. While I know 
that this plan gives fine normal developments 
in the epithelial cells of the mammary gland, 
I feel quite sure that it would prevent abnor- 
mal fatty degeneration. To show that this 
question occupies the thought of obstetricians 
I quote from the University Medical Maga- 



Regarding fatty degeneration of the uterus 
during pregnancy L. M. Bossif found this 
in active process in three human uteri, one 
removed at the eighth month of pregnancy 
and the other two at term. He inquires 
whether this is the physiological condition, 
and if so whether it may not explain the 



* March, 1897. 

\Annati di Obstetrica e Gynecologica, December, 
189b. 



49 

wonderful rapidity with which involution of 
the uterus after labor normally takes place. 
It may be asked further whether in this fatty 
degeneration there exists an explanation of 
some cases of inertia uteri in labor. Bossi 
has attempted to investigate the subject by 
the experiments on animals of tying the 
uterine blood-vessels, but does not regard the 
results as applicable to the human uterus. 

I suppose most clinicians agree that scar- 
let fever without the stigmata of fatty degen- 
eration is shorn of many of its perils. The 
signs of fatty metabolism and scarlet fever 
simply tally. Both may have albumen, fatty 
epithelia, and cylinders in urine, and dropsy 
in all forms; also diseased epithelia in urine, 
which have much to do with the cause of 
fever. I once saw a case where severe scar- 
latina occurred at the age of six years, but 
who died at the age of thirty-two, with ex- 
tensive fatty metabolism in heart, kidneys, 
liver, and brain, as the autopsy showed; be- 
sides, three years before death she had puer- 
peral convulsions under my father's care. 
Professor D. Humphreys Storer, of Boston, 
saw her in consultation; he then taught that 
these convulsions were due to fat metabolism, 
and certainly she had all the signs of it. She 
recovered. A year and a half later she had 
facial paralysis on the left side. Finally her 
death came from a second haemorrhage into 
the same ventricle, for I found it completely 
filled with a fresh clot of blood. I also found 
the fibrous remains of the first causal effusion 
inside the left lateral ventricle of the brain. 
The kidneys had the development of a child 
of six years. She never was well after this 
fever, and would probably have not lived to 



5° 

maturity had she not persistently kept out of 
doors during the day. 

The work of the kidneys is vicarious with 
the skin, and when invaded by scarlatina the 
result is these organs are overwhelmed, their 
functions rendered languid or impeded, hence 
fatty transformation. Surely the rashes of 
scarlet fever demonstrate that the skin is 
congested, its capillaries dilated, and its cir- 
culation impeded; and as the skin is the 
largest gland in the body, with twenty-five 
miles of sweat ducts, this dermal retardation 
and impeding must be an element in fatty 
degeneration when it occurs in this malady. 

Sclerosis is a term employed when the de- 
generation is of a denser substance than the 
tissues it replaces; its nature is twofold, fatty 
and fibrous. Regarding the former — as has 
been said before — when cholesterine replaces 
tissue it is apt to be accompanied by lime 
deposits which give the artery affected a feel 
like stone; of course fatty degeneration must 
follow, even if it has not preceded such sclero- 
sis. The mere obstruction to the circulation, 
for example, caused by the cholesterine is a 
sufficient cause. Fibrous thickening or ab- 
normal increase of white or curling fibrous 
tissue form another kind of sclerosis. This 
tissue is laid down in a weakened condition 
and possesses the first elemental cause of 
fatty degeneration, /.<?., retardation and im- 
peding of function; the microscope alone 
can make out surely the diagnosis of fat-ill 
sclerosis. Fibrous sclerosis is especially a 
food disease, and has been found amenable 
to diet. 

I have seen fatty degeneration accompany 



5* 
cancer of the schirrhous variety; my definition 
of cancer is "tissue under mob law." Mob 
law defies all rules, and it is not surprising 
that cancer should include fatty degenera- 
tions specially, as in no other organic disease 
is there more retardation or impediment to 
the functions than in the conditions called 
cancer. I have now a case of schirrhus of the 
left breast, where the urine and the blood 
show fatty degeneration. Physicians should 
look out for this complication in all cases of 
cancer and sclerosis. It is evident that when 
the systemic condition is one of fatty degen- 
eration the tissues under mob law and scle- 
rosis will more readily riot. The aim should 
be to get rid of the fat ill first. When shall 
we have a better name than " cancer?" 

Senile gangrene occurs when an embolus 
blocks an aged artery roughened by degen- 
eration. It impedes the circulation and in 
fact produces the very prime causes of fatty 
degeneration, which degeneration must also 
have come from the atrophy and wasting in- 
duced by the loss of the full normal blood- 
supply; sometimes the artery feels like a 
tube of stone or bone. Fatty ills are normal 
in old age as aforesaid. Senile gangrene 
sometimes appears like adipocere, a fatty 
degeneration occurring after death, and 
thought by some to be due to chemical 
changes away from the atmosphere. Good 
authority reports that meat kept under water 
sufficiently long will change to adipocere. 

A friend who had this disease was a rabid 
follower of the doctrine that " like cures like," 
and I could not get him to try the food treat- 
ment. One leg was amputated; also uie 



52 

other, I think, afterwards. He died. This 
was doing something contrary to his faith. 
Such surgery was done years before the 
Christian era. It is much easier to use knife 
and saw on a patient than to make him use 
knife and fork on food that he does not like. 
It is a good plan for the aged to drink much 
water, preferably hot, in order to keep the 
systemic salts in solution, and to have all the 
circulations clear and free as possible. 

Shaking palsy, Basedow's disease, paralysis 
agitans, tremor, are varieties of paralysis, 
slow acting, usually senile, and dependent 
mostly on fatty ills; probably some sclerosis 
occurs with them. As aforesaid, fatty and 
fibroid degenerations are often associated to- 
gether. The nerve centers of the brain are 
affected by the degeneration which interferes 
and cuts off supplies of initial ganglionic nerve 
force. 

M. Liegeois, in the Journal des Praticiens* 
states he has observed a permanent trembling 
of the hands in a woman who suffered from 
aortic insufficiency with visible capillary pul- 
sation. Certainly there was impeded func- 
tion here. It is interesting also to note that 
M. Liegeois advises for senile shaking of the 
limbs, accompanied by a transverse or ver- 
tical tossing of the head, an " analeptic re- 
storative diet, river bathing, and infusion of 
Chenopodium ambrosioides (Mexican or Span- 
ish tea)." 

This comes very close to the treatment by 
hot water (which is better than tea generally), 
by baths, and by feeding for shaking palsy. 



* Paris, August, 1896, 



53 

M. Liegeois deems polyneuritis to be the 
cause, but is not thickening of the nerve 
sheaths a part of polyneuritis? 

Shock may also be a fatty masquerade. 
An item in a newspaper under date of March 
19th, 1894, says: 

Commodore W. I. Whitney died in New York at 
the age of seventy-one. Two months ago he was 
knocked down by a cab in Broadway and fractured 
his hip. The bone united, but the shock from the 
injury brought on paralysis and also developed 
Bright's disease. In 1887 he resigned active ser- 
vice on account of failing health and almost total 
blindness, 

The history of this case reveals fatty ills 
for thirteen years. While it is true that the 
"shock" could have accelerated the paralysis 
and Bright's disease, still the causal lesion is 
all concealed in the unusually clear medical 
report as to this distinguished public man. 
The repair of the hip is very interesting as 
showing what Nature can do under unfavor- 
able circumstances. In my experience this 
is more than paralleled in the case of a lady 
sixty years of age. The bone united well, 
but she died a few months after of a cancer 
of the liver as shown by the autopsy, which 
must have existed for a long time before, as 
evidenced by a peculiar bronze, ashy coun- 
tenance, and by the death of a married sister 
a few years previous of cancer of the brain. 

The death of Doctor B. S. Codman of the 
surgical instrument firm of Codman & Shurt- 
leff, Boston, was said to be due to a fall — 
"the shock causing Bright's disease and peri- 
carditis/' As he was seventy-two years of 
age it is more than probable that this fatty 
degeneration was caused before the shock — 



54 

in other words, the gun was loaded before 
the trigger was pulled. 

Smallpox is often associated with fatty de- 
generation. When the natural history of this 
disease is considered it is, in the light of the 
principles laid down here, a sufficient cause 
for this disastrous fellowship. No matter 
which is the masquerade, the fatty ill needs 
treatment because this partnership may be 
the chief cause of the mortality. The weak- 
ened tissues are just so much a depressant of 
the vital forces as they are in proportion 
great or small. But what shall be said when 
the subject of smallpox is already invaded by 
fatty metabolism when attacked ? The popu- 
lar answer would be "the patient died be- 
cause he or she had no constitution to resist.'' 
And this would be objectively and theoretic- 
ally correct, — a system half fat would be 
phenomenally weak to resist any disease. 
Death would have more dominion over such 
cases of variola than where there was no 
such complication. Some go further and 
affirm that smallpox would not occur in a 
perfectly healthy person; there is good evi- 
dence for such a view. Is it wise to eat so 
that fatty degeneration may make patients an 
easy prey to smallpox? 

Softening of the brain is a term often heard, 
but I have yet to meet any who actually have 
seen this condition described save in symp- 
toms. It must be admitted, however, that 
such softening does exist, and from what has 
been said it must likewise be inferred that it 
is more likely to be due to fat metamorphoses 
than to anything else. The brain substance 
resembles fat; lecithin, one of the fat acids of 



butter, is found in normal brains; hence it 
must be an easy transition from normal cere- 
bral substance to abnormal fat. Indeed, a 
normal brain is not so dense as tallow or 
lard at a temperature of 4o Q . In some cases 
of softening of the brain I have read of there 
was an oily degeneration, and for these rea- 
sons I think it just to place this here as a 
masquerade. 

Syphilis may be a masquerade, and M. 
Liegeois mentions this disease as a cause of 
tremor. 

Doctor Henry A. Robbins in a letter to the 
writer under date of June 12th, 1896, says : 

tftf Its (syphiliV) favorite masquerades are 
6 fatty degenerations in all the vital organs, 
' and the symptoms are exactly the same as 
' you have beautifully described under ' Fat- 
' ty 111 Masquerades/ 

" In the post-mortem of a boy that died 
6 of hereditary syphilis was discovered un- 
' doubted fatty degeneration. I called it 
'' ramollissement' and ' extensive soften- 
'ing/ In 1874 Professor Heubner showed 
c that syphilis produced opacity, thickening, 
( and diminished caliber of the cerebral ar- 
' teries. interfering with circulation; throm- 
' bosis and cerebral softening. Doctor C. 
c L. Dana, of New York, at the American 
' Neurological Association, 1894, said : 
6 ' Taking hemiplegia as a whole I find 
6 syphilis in thirty-six of one hundred cases. 
' Syphilis causes one-third of all cases of 
'apoplexy/ Doctor Heck showed, at a 
1 meeting of the Medical Club at Vienna, 
i a babe, the second child of a syphilitic 
' mother, who when eight weeks old showed 
a syphilitic erythema which disappeared 
' under the influence of iodide of mercury. 
6 Later the extremities began to swell and 
'the urine showed albumen, hyaline casts, 



56 

" white and red corpuscles; it was cured by 
" potassium iodide. 

"Dr. L. P. Yandell reported (1878) in the 
" Maryland Medical Journal a case of syph- 
ilitic albuminuria: ' German, male, sixty 
" ' years old, with general dropsy, albumen, 
" ' casts, and renal debris in urine, pale waxy 
"'skin, puffy eyelids, constant indigestion, 
"'pain in back, disturbed vision, hemicra- 
u ' nia, muscular debility, frequent micturi- 
" ' tion. He was given one scruple of iodide 
u ' of potassium in skimmed milk or water 
" ' every three hours while awake. Dose 
" c increased ten grains daily with no bad 
" c symptoms nor discomfort. Iron and bit- 
" ' ter tonics were given at the same time. 
" ' Marked improvement at the end of a few 
" ' days. Throat rapidly healed. Strength, 
" ' appetite, and color returned. The urine 
" ' ceased to evince any sign of renal disease. 
" ' In two months he was well/ " 

Dr. Robbins says: " Syphilis gives rise to 
the train of symptoms identical with those of 
fatty degenerations." 

There is no room for more evidence. If it 
is true, as has been stated in court, that sixty 
per cent, of the human race are tainted with 
syphilis, it is clear that it may masquerade 
fatty degenerations. Certainly it furnishes 
one of the great primal causes of these ills 
— i.e., retardation and impediment of func- 
tion. 

For over twenty-five years the writer has 
found the detection in the blood of the automo- 
bile spores of the Crypta syphilitica to be the best 
test for syphilis. It is used without disturb- 
ing the patient, and is useful to decide when 



57 

the case is fully cured. No case is cured if 
the spores of the C. syphilitica are present. 

Since surgeons have found the Gasserian 
ganglia invaded by fatty degeneration it is 
probable that some of the cases of facial 
neuralgia, or tic douloureux, are due to this 
cause; this is more evident when is consid- 
ered the fact that angina pectoris is due to 
the same cause. Indeed, until there is a bet- 
ter clew to its real nature we had better hold 
on to this than be tossed about by the winds 
of clinical uncertainty and wavering doubt. 
The treatment for this degeneration is all in 
the line of good health for every tissue. Pain 
is usually due to partial paralysis; strike with 
a whip, and you hurt because the nerves struck 
are partially paralyzed; strike with an iron 
bar and you can paralyze the nerves so that 
they give no impression of pain, — a wholly 
lacerated nerve gives no pain. Hence in tic 
douloureux the interstitial and peripheral 
nerve changes may partially paralyze the 
sensory fibers and pain result; indeed, extir- 
pation is a last resort, to be tried when all 
other means fail; it is effectual simply by 
the destruction of the nerve which suffers or 
makes to suffer. Better try to produce nor- 
mal nutrition, so that the nerve makes no 
trouble because it has naught to complain of. 

I believe in the autonomy of nerves as well 
as of organs, and that a good deal of what is 
called hyperesthesia and neuralgia is simply 
the outcry of the diseased suffering part for 
relief. 

A recent* autopsy of a tuberculous case 



* November, 1896. 



58 

resulted in finding considerable sized masses 
of hard fat, granular fat bodies, and free oil 
in the diseased lung along with the tuber- 
culous matter, which impels me to suggest 
these were simply masquerades. Certainly 
there is impeded and retarded function in a 
lung infiltrated with tubercles, which impedi- 
ment is causal of fatty metabolism. The 
Micrographic Dictionary is quite clear on 
this point: 

Tubercle appears to originate most frequently 
from the tissue which surrounds the small arteries 
in every situation, constituting the lymphatic 
sheaths. The small cells multiply at separate 
centers and thus miliary nodules are produced 
around the vessel; and as they gradually develop 
they compress the vessel, and may finally occlude 
it. Tubercle invariably undergoes a retrogressive 
change; this commences in the center of the granu- 
lations, and consists in the atrophy and incomplete 
fatty metamorphosis of the closely crowded cellu- 
lar elements, constituting what is termed casea- 
tion. The translucent and gray granulations thus 
become opaque and yellowish, the yellow tubercle 
being merely a stage of the granulation. The case- 
ous tubercle subsequently softens, or may gradually 
dry up into a firm cheesy mass, which ultimately 
becomes calcified.* 

So here fatty and tuberculous degenera- 
tion are intimately connected pathologically. 
Dietetically they are also connected, as car- 
bohydrates in excess are causal of both tu- 
bercle and fat ills. 

The laborious, careful, accurate, and exten- 
sive contributions of the late Doctor Joseph 
Jones, of New Orleans, as to the natural his- 
tory of yellow fever impress one with the 



*Page 785, Edition 1883. 



59 

idea that fatty degeneration is a great clinical 
element of the debility, pain, prostration, and 
danger therein. Fattily degenerated tissues 
are physiologically and physically weak; in- 
deed, they are a pathological element of 
great power to destroy life, for the said 
tissues are already half dead. Be it that the 
vegetation (Freire's) is a physical cause of 
the fatty metabolism, still it is the duty of 
the clinician to remove the abnormal fat 
transformation by aiding Nature. It is a 
hard enough situation to have a noxious 
vegetation to fight in addition to debilitated 
tissues, hence the close relation of dietetics 
to yellow fever. 



IV. 

FATTY DEGENERATION A PRESERVATIVE 
PROCESS. 

We find such to be in the living as well 
as the dead. For example, the arterial 
muscles, the eyes, and the kidneys last 
longer because of this ill than otherwise 
they would have done under the retarded 
and impeded function to which they have 
been subjected. In this view it is not a 
wonder that deaths result from fatty ills. 
To state this differently, the idea is that 
from the partial paralysis and from the 
impeded or retarded circulation or other 
function of a part the tissues are prevented 
from at once dissolving entirely away, by 
the infiltration and substitution of fat in 
its various forms, especially w T here the 
diathesis is gravelly and where there are 
calcareous deposits. Thus time is given 
for repentance and repair, which, if taken 
advantage of by the use of food which 
does not paralyze by its gases evolved 
through fermentation, Nature will then 
metabolize normal tissues in place of the 
abnormal. 

The idea is in line with what happens 
when the body systemic gets into other 
troubles. If the body is burned pain fol- 
lows, which calls attention to the injury. 
Vomiting is another function that is some- 
times curative ; even dogs know enough 
to eat grass as an emetic when they have 
devoured bad food. Diarrhoea is some- 
times curative. Indeed, it may be said in 
general terms that most of our diseases in 
their early stages are Nature's warnings 
or appeals for our stopping physiological 
sinning. 

60 



V. 

THE DIAGNOSIS OF FATTY DEGENERATION. 

The clinical morphologist, while not 
ignoring at all the work of the post-mortem 
detective,* is obliged to use skill before 
death, since his business is the practical 
diagnosis and treatment of sick persons, and 
it is of deepest interest to find out fatty de- 
generation before death, and it is of the 
deepest interest to cure fatty degeneration. 

Coming in contact with a fatty masque- 
rade, or with a case in the pre-stages in 
which cases are easy to treat and hence 
more needful to discover them, the first 
business is to ascertain whether there is 
liquid fat from beneath the skin in a blood 
specimen. To do this use a clinical or 
other microscope with one-inch ocular, a 
one-fourth or one-sixth inch objective, a 
slide, cover, and needle or scarificator — 
Cutter's, if you like. 

Never take the finger for collecting 
blood; take the bared wrist, previously 
cleaned with soap and water if need be, 
in the left hand in such a way that the ra- 
dial edge is uppermost and the skin made 
tense by the fingers and thumb of the 
hand. Then with needle or scarificator 
make a puncture. If the blood does not ex- 
ude readily, as is likely to be the case when 
the circulation is weak, slow, impeded, 

* " The discovery of the fatty degeneralion of tis- 
" sues is probably one of the most valuable fruits of 
" microscopic research in regard to medical science ; 
" for it has shown to us that maladies, supposed for- 
11 merly to rise from too great abundance of the circula- 
" tory fluids, have really had their origin in a decayed 
" state of the tubes and vessels in which the fluid was 
" contained, and that the natural process of human 
" decay, as it called, is a morbid process of disease, 
11 probably to a certain extent as remediable or pre- 
"ventable as many other diseases to which man is 
" liable " (Micrografihic Dictionary, 1S73). 

61 



62 

and languid, squeeze the wrist hard. Some- 
times a deeper puncture is needed. When a 
drop of the size of a common pin-head ap- 
pears, touch the center of the slide to the 
drop, or remove with a knife, and, imme- 
diately covering, put on the stage of the 
microscope. If it is a case of fatty degen- 
eration there will be observed in the field oil 
in globules and protoplasmic forms, varying 
from granules to sizes that fill almost the 
whole field. The idea is that in thus exam- 
ining healthy blood there should be no fat in 
the field in the form of oil or liquid fat. To 
be sure, the fat comes from beneath the skin; 
but normal fat should be hard, more like a 
stearine candle. The margaric acid should 
be solid, embraced in the delicate walls of 
the fat cells under the skin. The globules 
should appear like little grapes in clusters 
quite uniform in size. 

Regarding fat acids in man: It is an inter- 
esting subject to study whether the normal 
stearic, margaric, and palmitic acids, which 
are solid or semi-solid in the healthy human 
body, change their atomic composition by 
becoming oleic acid in fatty degeneration. 
The formulas are as follows: Oleic acid, 
C 18 H 34 8 ; stearic acid, C 18 H 35 2 ; mar- 
garic acid, C 1 ,H 34 2 ; palmitic acid, C 16 - 
H 32 2 . If, then, what we have been taught 
aoout oils is true, the fatty change is when 
margaric acid becomes oleic acid and adds 
one equivalent of C, while two equivalents 
of H are removed from stearic to make oleic. 
The change to oleic acid adds two equiva- 
lents of C to palmitic acid. 

But what is this for protoplasm to do, when 



63 

protoplasm makes the very complex sub- 
stances, milk, bile, sweat, mucus, gastric 
juice, to name no more, from mammalian 
blood ? Truly, as the Psalmist says, " We are 
fearfully and wonderfully made ! " Has man 
ever made anything equal to the commonest 
epithelial cell ? Incidentally remarking this 
to one of the greatest organic chemists in 
the world, he mentioned his surprise at the 
fact here stated; but he would not express an 
opinion, as he did not know all the literature 
of the subject. I wish all we physicians 
were as wise in the expression of sentiments 
when any new thing is brought to our notice. 

Regarding fat in the white blood-corpus- 
cles: This means of diagnosis has been used 
for many years in America, as a sign of im- 
pending or pending apoplexy; but the fat 
globules are very small and liable to be mis- 
taken for entophytal growths of syphilis, ec- 
zema, chyme, etc., and may also be present 
along with the leucocytal fat. But fat in 
blood after meals is usually more outside 
than inside the leucocytes, which are unapt 
to absorb the post-prandial fat. 

If fat in the white blood-corpuscles is found 
in conjunction with fat acids, one may be 
quite sure of the situation as one which, if not 
fully characteristic of fatty ills and their 
masquerades, marks the fact that they are 
coming on, and hence, as said before, the 
time to repent, reform, and repair has clin- 
ically come. 

Usually there are but one or two minute 
globules of fat in one leucocyte, and situated 
away from the periphery. Sometimes they 
bud from the periphery. Their minuteness 



6 4 

is no bar to their significance nor their de- 
tection. In very marked cases fat granules 
are found in all white corpuscles; in less 
marked in only a few. 

Thrombi and emboli of fat are sometimes 
macroscopic or visible to the naked eye, and 
they also are diagnostic of fatty ills. 

It is a good plan to study milk, oil, melted 
butter for fat appearances so as to be familiai 
with the foregoing. 

Morphology of muscular fibers: In sus 
pected cases cut through the skin and with a 
barb tease out (from the deltoid muscle, for 
example) a portion of the fiber; this will 
give at once a decided test of fatty degener- 
ation under the microscope. If such degen- 
eration is present, granules and globules of 
oil will be seen invading and replacing the 
fibrillae; but if the degeneration has gone 
thus far it should show signs of its presence 
in the blood and urine, rendering this process 
needless. 

Pigment matters: " Along with fatty de- 
posits go amorphous finely granular protein 
matters and occasionally pigmentary degen- 
eration in the form of brown, bronze, yellow, 
red, black, aniline-blue and emerald-green 
bodies, together with amorphous or crystal- 
line calcareous salts, as the carbonate of lime 
(calcareous degeneration)."* When these pig- 
ments are found in the blood, sputum, or 
urine, they must be regarded as in some de- 
gree indicating the presence of fatty degen- 
eration somewhere in the body; they also 
indicate impeded portal circulation. The 



^Micrographic Dictionary. 



65 

beauty of these pigments sometimes is great, 
and such exhibitions increase admiration for 
the human body as "a temple of the living 
God," which even in ruins is " beautiful 
within." These pigments in the circulation 
have been connected with rheumatism, which 
is "a gravel of the blood." They are prob- 
ably excrementitious substances that the sys- 
tem would throw off if the normal functions 
of its morphological elements were not in a 
languid or interrupted condition. They are 
found in the pre-stages of disease, where the 
health is apparently good; are brilliant signs 
that trouble is brewing; and liberal doses of 
water are indicated. 

Morphology and chemistry of the urine: 
In dubious cases study this daily for weeks 
if not months. 

The writer forty-three years ago studied 
this morphology under Professor Josiah P. 
Cooke, LL.D., at Harvard Medical School, 
and ever since, and perhaps it may be al- 
lowed him to express surprise that: So few 
physicians pay close attention to the clinical 
morphology of the urine: That so many phy- 
sicians get an apothecary or young medical 
student to examine urine for them: That 
they do not know how much they lose 
by these courses, and: That they will so 
carefully look after the one rill of the tem- 
perature of the sick, but neglect the small 
ocean (urine) of physical signs, which gives 
far better indications of the real condition of 
the patient. Both the temperature and the 
morphology should be used. Convention- 
alism aside, I know that the good intended 
by these presents will be defeated if the 



66 

morphology and chemistry of the urine are 
ignored. I speak from experience when I 
say that but for my own daily personal 
study of urine I could not have presented 
these facts, nor have tried to inspire others 
with the hope that they will cure fatty ills. 

Regarding albumen, in greater or lesser 
degree: Doctor Stewart* says: " Albumen 
is not present in some cases of Bright's dis- 
ease." I think, however, had he systematically 
examined such urine voided in the morning 
before eating, daily for weeks or months, 
albumen would have been found; but I do 
not affirm this of a certainty, not having seen 
his cases. Albumen should show by heat, 
nitric acid, picric acid. Albumen may be 
present without fatty degeneration or inter- 
stitial nephritis; cylinders are also found 
without albumen. Albumen in the urine may 
come from uterine reflex, from kidney or 
uterine congestion, from irritating drugs, 
from turpentine inhalation; but whenever it 
occurs alone, although it may not be diag- 
nostic of degeneration, it certainly is a sig- 
nificant indication of something wrong. So 
long as remedial means will remove it duty 
demands to do so and not to let albumen 
run on to waste. Again, the source of this 
albumen is the blood. It exosmoses from 
the Malpighian bodies and epithelia of the 
kidney tubules, whose complicated and knot- 
ted structure renders a retarded or impeded 
circulation possible and easy; hence the 
favorite location of fatty ills, as well as the 



* Journal of the American Medical Association^ 
December, 1893. 



6 7 

frequency of the occurrence of these ills, in 
such never idle organs. 

Fatty epithelia in the urine: Epithelia are 
the chief autonomic agents of the production 
of urine; why they secrete urine is not ap- 
parent from their physical appearances. The 
protoplasm which does their work is not to 
be visibly distinguished from the protoplasm 
of other epithelia, which secrete wax in the 
ear, milk in the breast, or juices in the ali- 
mentary canal; each has its own life-work; 
they die, are thrown off, and washed away in 
the secretions; are described as pavement, 
cylindrical, and fusiform; are not very per- 
ishable, and retain their characters for a long 
time, — there is hardly any natural potable 
hydrant water but contains epithelia; they 
survive soaking, like hair, hoof, and nails, 
which are modified forms of epithelia. 

Epithelia of the fattily degenerated kidney 
become subject to an internal deposit of fat 
in globules of varying sizes and numbers, 
sometimes of awry protoplasmic shapes, 
which form conspicuous objects under the 
microscope. Focusing off and on, the play 
of color and shade will be found diagnostic. 
Where fatty epithelia are present alone — i.e., 
without albumen and cylinders — in a sus- 
pected specimen of urine, I have seen them 
disappear very rapidly and not return after the 
treatment has been suspended. When pres- 
ent they show as well as any physical sign 
that fatty degeneration is somewhere in the 
body, provided that fatty food has not been 
eaten in excess, and vaginal epithelia that 
have imbibed vaseline or some other fa* are 
not mistaken for nephritic epithelia. Not all 



68 

the epithelia in the same specimen of urine 
are fatty; two or three individuals suffice as 
witnesses. 

It should be remembered that epithelia are 
sometimes invaded by urinary salts, uric acid, 
oxalate of lime, carbonate of lime, urate of 
soda, triple phosphates, cystine, and so forth. 
When saline bodies are rapidly deposited in 
granular form they might be mistaken for 
fat; but the presence of these salts in the 
urine, and their different refraction of light, 
will help to make the correction. The sub- 
ject of intracellular salts is beautifully illus- 
trated in the parenchymatous cells of a com- 
mon grape skin, where crystals of cream of 
tartar occur in large bundles of needles. 

Casts of kidney tubes: These are best de- 
tected by a one inch objective and ocular; it 
is well to have a large and uncovered cell 
\y 2 inches long, % inch wide, }i inch deep. 
This may be made by cutting a parallelogram 
of sheet lead ^6x3x1 inch, soldering same to 
common glass slide, by heating the slide, so 
that it will melt sealing-wax, on to its upper 
surface; the slide should then cool. The 
perforated lead plate is next heated hot 
enough to melt the sealing-wax into which it 
is embedded, and when cool is ready for use. 
If the steps have been properly taken a good 
job will result, because the principle of sol- 
dering is to heat the substance to be soldered 
up to the melting point of the solder, and not 
to apply the melted solder to colder surfaces 
that chill and will not coalesce with the sol- 
der. The advantages of this open cell are 
more celerity and larger field of observation 
than when a cover-glass is used; besides I 



6 9 

have found that the cylinders will most readily 
escape from beneath the glass cover when 
the excess of fluid is removed by some bibu- 
lant, so that the cover- glass will not slide off 
when used on the conventional stage. 

The urine collected before rising from bed 
in the morning should be allowed to stand a 
few hours, preferably in a conical vessel 
(wine-glass) or in a common bottle — specially 
where the suspect contains but few casts, and 
when it is clinically important to detect the 
pre-stages of the disease. This gives time to 
settle to the bottom, whence the pipette 
readily reaches and transfers to the slide, 
which must be placed on a horizontal stage, 
else the specimen will escape. — Those who 
prefer the conventional microscope can use 
the horizontal stage by placing the micro- 
scope upon a chair of the same height as that 
on which the observer sits; if the chair is not 
high enough, the microscope can be put on 
the microscope box or some other support; 
or one may use the J. Lawrence Smith chemi- 
cal microscope, where the stage is above the 
objective; or the clinical stand may be used, 
mounted on a horizontal bar of wood a foot 
long and two inches square, provided with 
legs six inches long, and in the center a hole 
bored vertically, in which the tube of the 
stand fits tightly, but capable of move- 
ment. For forty-three years I have used 
an Amici stand, which gives a horizontal 
stage. There is no good reason why this 
Italian stage should not be conventional to- 
day. Folks follow fashions in microscopes 
as the ladies do in dress. I insist on the low 
power; the one -inch will detect cylinders 



7° 

after the one-quarter-inch objective has failed, 
because of the great transparency and shadowy- 
ness of the casts. — The ocean looks blue, but 
a tumblerful of sea water shows no blue color; 
thus low powers excel the higher sometimes. 

The casts are cylinders like candles run in 
a mold. In the fatty degeneration of the 
nephritic tissues the fibrin and albumen of 
the blood come away so freely as to form 
molds, castings or "casts," or cylinders in the 
kidney tubules; afterwards they shrink, are 
washed away by the urine secreted, and to 
be detected as above described. 

From a clinical standpoint the kind of cast 
practically makes little difference, as all are 
forms of fatty degeneration, subjects of the 
same causes and amenable to the same treat- 
ment. If causes cease, Nature, furnished 
with good organized and organizable food, 
will end the casts, no matter whether hyaline, 
fatty, epithelial, waxy, etc.; the main thing is 
to restore the impeded or retarded functions. 

Pseudo casts are also encountered in urine, 
and clinicians should know them: . For ex- 
ample: Those which are more like carrots 
than the true straight broken-off casts: Those 
which sometimes have appended a long fila- 
ment, usually coiled like a spiral spring. 
These false casts are thought to come from 
some of the many reentrant glands that open 
into the urethra, and from the spermatic 
ducts of the male urethra; they often occur 
along with the true casts, are abnormal, and 
usually disappear under the same treatment 
that carries off the true casts, 

Amyloid bodies are subs f ances composed 
of nitrogenous matter closely allied to albu- 



7i 

men; are colored deep reddish - brown by 
iodine; occur in tissues and organs affected 
with waxy or lardaceous degeneration, as the 
small , arteries, the liver, the kidneys, the 
spleen, the breasts. Though amyloid is con- 
sidered by some as normal with brain sub- 
stance, in my own opinion such is the first 
formed substance in fatty degeneration— in 
other words, amyloid is the first evidence of 
fatty degeneration of the kidneys when found 
in the urine, and it is the last to leave when 
the ill is recovered from. The physical ap- 
pearances of amyloid bodies are like starch 
— hence the name, starch; they vary in size 
like wheat starch, and each has a hilus some- 
times. No doubt common starch, accident- 
ally present, has been mistaken for amyloid; 
hence it is important for clinical purposes 
that all vessels holding urine should be clean. 

In doubtful cases the clinical morphologist 
should know whether there is no admixture 
of starch from the outside; this is the more 
needful because rarely is the morphology of 
the air examined without finding starch pres- 
ent. Voiding the urine into a clean vessel, 
and collecting the sample with a clean pipette, 
is generally sufficient. Another source of 
error is that sometimes the globar mother 
mucous cells found in the urine are distended 
by a glassy nacreous hyaline substance, which 
indeed may be amyloid, and has been found 
in the blood. Three hundred diameters is 
the best power to use for its detection. 

Vegetable amyloid may be studied in the 
haricot bean and in the rhizome of sarsapa- 
rilla; it is regarded as a transition substance 
between starch and cellulose or woody fiber. 



72 

Free oil in urine is a somewhat startling 
sign of fatty ills, indicating that the tissues 
are so much broken down and in so ad- 
vanced a stage of degeneration as to be 
changed into liquid fat or oleic acid; hence 
it is doubly important to eliminate all sources 
of error, and to avoid wrong conclusions. 

Sometimes the vial in which the urine is 
sent for examination has been used for oil, 
though the patient may assert it was "washed 
clean." It is a fact that when oil of any non- 
volatile nature has been in a bottle for some 
time no ordinary washing will cleanse it; 
thus old castor-oil vials used for urine have 
bothered me much. Before coming to any 
conclusion as to the significance of liquid fat 
in the urine, it is best to be sure it is not 
foreign. Where it can be done the patient 
had best void the urine into vessels of known 
cleanness. I have known a pipette, previ- 
ously used for oil, to nearly become a source 
of error. — It is surprising how much cleans- 
ing such a pipette needs; oil clings and is 
capable of the minutest subdivision. A late 
paper read before the Royal Institution, Lon- 
don, on "Foam," states that films of oil have 
been measured less in thickness than the one- 
millionth of an inch ! The persistent fra- 
grance of ointment found interred with mum- 
mies for three thousand years is another 
example of the minute subdivisibility of mat- 
ter and its persistence. As oil is of less 
specific gravity than urine it floats to the 
top, but this is not always so, for I have 
found it at the bottom, though I cannot ex- 
plain this. 

Urinary catarrh may be mentioned as an- 






73 

other source of error, for in conducting daily 
urinary examinations it has been found that 
one day albumen, fatty epithelia, kidney 
casts, one or all, would be present, while on 
the next albumen, casts, and fatty epithelia 
would be absent; that protoplasmic, filamen- 
tous, or Indian club catarrh (colloid) would 
be present; that on a third or later day albu- 
men or casts or fatty epithelia would be 
present, and perhaps the day following only 
the colloid; that on a succeeding day the 
urine would be normal; that afterwards the 
albumen, casts, and fatty epithelia would 
again be present. 

This experience of varying conditions has 
been common with me for ten years and 
more. This shows a kinship or relationship 
between these catarrhs and fatty degenera- 
tion, a fact which is very interesting and 
practically useful. It shows too that prob- 
ably both fatty degeneration and this catarrh 
may be dependent on the same cause, to wit, 
languid or interrupted cell and other organic 
functions. They both disappear under the 
same treatment, therefore when these catarrhs 
are found in the urine it is advisable to look 
for albumen, casts, and fatty epithelia. There 
is no doubt but the nervous prostration 
resulting from the colloid catarrh, super- 
added to the loss of force occasioned by the 
albumen, casts, and fatty epithelia, constitute 
a doubly powerful agent in the production 
of neurasthenia in all its most aggravated 
forms, — for example, the so-called cases of 
heart failure. 

In observing urinary catarrh it is a good 
plan to let the urine stand over night or for 



74 

twelve hours before studying; to pipette from 
the bottom of the fluid; to employ a large 
cell on the horizontal stage; to use a one- 
inch objective and ocular; to study at least 
six successive specimens for six successive 
days, one each day, before deciding the diag- 
nosis. It is true that urine just voided will 
generally show this morphology, but most of 
the subjects of this catarrh are neurasthenic, 
curiously self-possessed, with the idea that 
they " know it all;" are usually chronic cases, 
much disgruntled with the shortcomings of 
the medical profession, if they do not damn it 
outright; if one is going to have any hold on 
them afterwards (as he ought to, to cure 
them) he must be very careful to let them 
understand he is not doing any guesswork; 
indeed, such a slow course is really best for 
the attendant, because the natural history of 
the case is thus obtained. Sometimes this 
rapid shifting of the signs in the urine from 
normal to abnormal and vice versa makes 
matters unpleasant for the physician. For ex- 
ample, a country practitioner found albumen 
in the urine, and, as do many examiners, with- 
out looking for the casts and fatty epithelia, 
he diagnosed Bright's disease; next day he 
sent him to consult with a city expert who 
found no albumen, and chided his country 
brother for his ignorance and presumption. 
Probably both were correct, and it was one 
of these alternating cases of albuminuria and 
catarrh ! In my opinion they are very com- 
monly met with and masquerade under the 
names of many formidable diseases. 

I may add that urinary catarrh is not con- 
ventionally regarded as a significant physical 



75 
sign of disease. In justice to myself and 
others I must aver that I have found urinary 
catarrh to be the only marked symptom in 
many cases of neurasthenia, and the cases 
were cured when the catarrh was removed. 
I feel justified in placing a clinical impor- 
tance on this colloid catarrh, and not to let 
go of the clew it gives to relieve suffering. 
As to disagreement, it is well known that at 
the Berlin International Medical Congress, 
1890, the most celebrated physicians differed 
about ether: Doctor Wood was called from 
Philadelphia, four thousand miles, to tell how 
to give it, though used successfully for more 
than fifty years in millions of cases by thou- 
sands of professionals! Then how can it be 
expected that all would think alike on this 
subject of urinary catarrh, so little known, 
requiring technical skill to detect and under- 
stand, because latent, insidious, changing, 
and eluding the highest powers of the micro- 
scope ? 

Fatty epithelia can be artificially produced 
(as by gynaecologists) by placing cacao but- 
ter, lard, or vaselin in the vagina, and on the 
morrow examining the morphology of the 
discharge. Epithelia imbibe fat by contact, 
and this should always be remembered when 
making diagnosis of fatty ills in women. Vag- 
inal epithelia are common in the urine of the 
female. The same is true of fatty matters 
applied to the skin; and dermal epithelia are 
flatter, denser, drier, and more wrinkled than 
vaginal. Recently I detected oil in the urine 
of a patient, and found it came from a daily 
bath of olive oil. 

The macroscopic physical signs are open 



7 6 

to the unaided vision; but are not to be 
depended upon always, at least not until 
corroborated by the microscopic. A drunk- 
ard's nose, carbuncular, enlarged, knobby, 
greasy, whitish pale, is perhaps the most 
prominent macroscopic physical sign of fatty 
degeneration. Other signs are oedema of 
eyelids, dim vision, dilated pupil, lack of 
bodily or mental vigor, green ground glass 
pupil, arcus senilis, weak stridulous voice, 
insanity, old age, etc. 

Fatty degeneration is very common in per- 
sons over fifty years of age; and fatally 
complicates pneumonitis and other diseases 
because it removes a portion of the power of 
vital resistance. It is found in society which 
mainly lives on starches and sugars, because 
social ethics decide that white flour breac 
and sugar foods, not to mention confections, 
are the proper aliments for people to sub- 
sist on, for the reason that they are aesthet- 
ically beautiful to the eye and palate. So 
long as people live to eat, and do not eat to 
live — that is, so long as sugar is advocated, 
even by chemists (curiously); so long as 
Count Rumford formerly, and the French 
people now, regard as good food all that 
pleases the palate; so long as the chemical, 
physiological, pathological, histological, ki- 
netic, and thermal aspects of food are practi- 
cally so completely overlooked and ignored 
by the ethically aesthetic; just so long will 
there be an abundance of fatty degeneration 
everywhere among civilized men. To offset 
all this may be employed winter and summer 
migrations on land and sea; physical bodily 
exercise; bicycling (moderately); fishing and 



77 

hunting in the pure open air of desert places; 
avoidance of carbohydrate liquors; promo- 
tion of downward peristalsis; prevention of 
fermentation in food eaten; proper expulsion 
of intestinal and stomachic gases; normal 
mental and moral activity, etc. These alike 
help to ward off and to mitigate fatty ills 
which come from allowing the love of the 
beautiful to determine the selection of foods 
to the exclusion of other more important 
selective standards. 

The heart's sounds are muffled, softly pro- 
nounced, and weak in fatty degeneration; it 
is as if a thick woolen blanket intervened be- 
tween the ear and the heart. The normal 
.hrill is of a quality like that of the deltoid 
muscle in action, but in fatty ills this is not 
transmitted to the tympanum, simply because 
the fatty interstitial fibrillae dampen the 
sounds by their non-conductivity, — the fatty 
fibrillae act like the felt dampers of the piano- 
forte, and they substitute the number of 
fibrillae able to contract and give forth sound. 
As the diseased fibrillae are replaced by nor- 
mal fibrillae, so the loudness, clearness, and 
penetration of the heart sounds increase, 
giving various grades of intensity from 
almost inaudibility.* 

* Thus auscultation becomes a kind of measure where- 
with to gauge the improvement, and on the other hand 
a gauge of the devolution or retrogradation of the case. 

Some may demand that this be proved by an autopsy, 
and so it might if we were veterinarians, who slaughter 
their bovine patients to see if they are diseased, and 
sometimes find five out of thirteen condemned tubercu- 
lous cases healthy; but as this is impossible with human 
patients, medical men must be content to abide by the 
entire disappearance of all physical signs of fatty de- 
generation as already detailed, and be satisfied with 
the restoration of the fatty-ill patients to perfect health 
— E. C. 



78 
The auscultation of lungs necrosed and 
breaking down by fatty degeneration differs 
not from the auscultation of tuberculous 
lung necrosis; indeed the two may be found 
together. The morphology of tuberculous 
lung blood is the great means of distinc- 
tion between lung tuberculosis and fatty 
consumption or necrosis of the lungs. The 
percussion signs are the same as in tubercu- 
losis of the lungs. If one places the key- 
note of normal chest percussion at F, fourth 

then per- 
dulness 
as F in 



m 



M 



line of the bass clef 
cussion of complete 
may be represented 
first space below bass clef, i.e. 
and varying between these 
notes according to the amount ■ — ^5 
of density of the lung tissue under observa- 
tion. 

Mensuration is the same as in tuberculosis 
or other ordinary disease. 

The dulness on percussion of a fatty heart 
is not so distinct as the dulness of cardiac 
muscular hypertrophy. 

Over cavities formed by fatty necrosis of 
the lungs the percussion will be as if the 
cavities were tuberculous. 

Note. — Fattily degenerated tissues pit on pressure, 
as in oedema of the legs, bat the pit is of briefer exist- 
ence and there is more resilient resistance to the 
finger. The resilience to the touch given by fattily 
degenerated tissues is not that of healthy tissues. 
This can be learned best by actual trial of healthy and 
obesic tissues. 

It should be remembered that fatty tissues vary 
from a normal tilting elastic resilience, when the mar- 
garic acid fat is solid as it should be (somewhat like a 
stearine candle), to the greasy, oily, lardaceous, unsolid 
feel of liquid fat under the tissues that is of oleic acid. 
It seems almost incredible that margaric acid in human 
fat should change under ordinary temperatures to oleic 
acid fat, but clinical experience authorizes this state- 
ment. — E. C. 



VI. 

TREATMENT OF THE FATTY ILLS AND 
THEIR MASQUERADES. 

In treating fatty degeneration the prin- 
ciples are general and particular. 

Regarding the former, it is " Nature 
that cures/' if allowed the opportunity — 
that is, the vital forces, actual or potential, 
operate to restore normal tissues in place 
of the fattily degenerated. This doctrine 
I endorse from facts occurring within my 
own personal knowledge for many years. 

To accomplish this the causes of fatty 
degeneration must be stopped. If these 
causes are the languid or interrupted func- 
tions of the tissue cells, such functions 
must be made active and constant. 

In case it is a ligature that impedes or 
interrupts functions by pressure (as when 
fatty ills are caused by a string tied around 
a limb), that ligature must be removed. 

The cell functions then may and gen- 
erally will be restored, because Nature, 
furnished with a proper blood-supply, 
will have a chance to work, while a li- 
gated limb cannot have normal exercise 
to quicken circulation. Hence the gene- 
ral principle as to clothing and body en- 
vironments, that they should not act as 
compressors, but be worn like a well- 
fitted bandage support. It is a physio- 
logical sin to impede or retard the cir- 
culation by means intended for protection 
from the weather and immodesty. If the 

79 



8o 

cause is from paralysis occasioned by too 
much gas in the alimentary canal, arising 
from a fermenting diet, then this diet must 
be stopped. In this line comes the with- 
drawal of foods, especially drinks containing 
carbonic acid gas, Seidlitz powders, soda- 
waters, champagnes, sparkling liquors, etc. 
Lately a lady of sixty-five years, whom I 
knew to be in the fatty-degeneration time of 
life, suddenly and unexpectedly died in the 
arms of her son, and the cause of her demise 
was given as "heart failure" (a result, not a 
cause). Her heart had troubled her some- 
what, though she was not thought to be ill. 
One evening she had some indigestion (which 
means excessive production of C0 2 , gas) in 
the stomach. For relief she took a Seidlitz 
powder, which also developed C0 2 . It was 
an unwise procedure, inasmuch as she was 
already embarrassed with C0 2 enough to dis- 
tress her weak heart ! It was late at night, 
and she had retired. Fearing that her son 
had gone to sleep down-stairs, she arose, put 
on loose clothing, and went down; and when 
she came to him she would have fallen dead on 
the floor but for his arms ! I did not see her 
after death, but it is probable that the heart 
was fattily degenerated, and that the C0 2 
combined with the extra exertion to rise 
from a recumbent posture was a sufficient 
cause of death. Again, at a club annual 
dinner, on a Saturday evening, Doctor Blank 
was present as well as myself. On Monday 
morning the Doctor was found dead in bed 
of " heart disease/' Liquors charged with 
C0 2 were drank by the deceased at this din- 
ner; and although fifty-two years old, he ap- 



8i 

peared more senile than some at sixty-two. 
If I am correct in assuming that he lived 
well at this and other clubs, then it is quite 
possible his heart was undergoing fatty de- 
generation, and was upset at about 2 or 3 
a.m., which is the usual time for such deaths, 
because the C0 2 accumulates to its maximum 
about these hours. 

These cases are mentioned as they were 
close to my knowledge, and hence excite 
(laudably, I think) an intense desire that the 
lessons taught by these sudden heart disease 
deaths should not be lost on myself and those 
I can influence. At the said dinner I drank 
water only, thus making myself so unconge- 
nial to a Yale alumnus next to me who drank 
wine that he changed his seat. I suppose I 
was thought by him no fit companion; but I 
experienced no discomfort from my absti- 
nence, but on the contrary my digestive 
organs next day were greatly at peace, and I 
ran no risk of upsetting my heart. I belong 
to a family where most of its paternal males 
died of heart disease at about the age of 
sixty years (my own age). Had I not known 
what I here assert regarding heart disease, I 
think I should have died in like manner be- 
fore this, especially as I have reasons for be- 
lieving that my heart is hypertrophied. 

To reiterate: Those fed on fatty foods to 
excess are prone to become fattily degener- 
ated; hence it is a general principle of treat- 
ment that fatty foods should be avoided. 
Cream, milk, and butter are the least objec- 
tionable, but even they will sometimes keep 
albumen in urine. Suppose a patient with 
fatty ills has been relieved of albumen, casts, 



82 

and fatty epithelia in the urine, and takes 
cream or any other fatty food, and afterward 
the albumen, casts, and fatty epithelia are 
again found in the kidney secretion, or fatty 
white corpuscles and oil are found in the 
blood, or free fat in the faeces — are not these 
sufficient clinical reasons for the abstinence 
from such foods ? This very experience hap- 
pened recently in a patient suffering with 
consumption of the bowels and fatty degene- 
ration. 

No clinician can expect to handle fatty ills 
successfully unless versed in the micrographic 
study of the above morphologies. No mat- 
ter how well the patients appear, the case is 
not complete unless the physical exploration 
shows normality in the form elements of 
liquid tissues. 

Unless there are some special indications 
demanding, alcohol should not be continu- 
ously used in cases of fatty degeneration. 
Employed as a beverage it acts as a cause 
of fatty degeneration, for not only is it a 
carbohydrate and hence easily transformed 
into fat, but it likewise interferes with nutri- 
tion and other functions of the cell tissues, 
to the production of fatty ills, — as seen in 
the toper's cauliflower excrescent nose, in 
fatty and fibrous livers, eta 

Of like character to alcohol must be con- 
sidered carbohydrate foods, since when taken 
in long-continued excess they undergo alco- 
holic and vinegary fermentation in the ali- 
mentary canal, as shown by the alcohol yeast 
plants, the vinegar yeast plants, and the C0 8 
which always goes with alcoholic fermenta- 
tion, and is seen in raising bread with yeast. 



8 3 
Or to reverse this statement: The presence 
of C0 2 gas in the alimentary canal proves 
the presence of alcohol, because one is not 
evolved by the yeast protoplasm without the 
other from fermenting carbohydrate foods. 
Indeed, I believe in the statement that the 
teetotallers who suffer from the brewing of 
alcohol C0 2 and vinegar in sour stomachs 
are more numerous than those who similarly 
suffer from intoxicating distilled liquors. It 
often happens that when total abstainers, 
bloated with C0 2 gas and showing signs of 
fatty ills, are taken off from their carbohy- 
drate foods altogether they will act and feel 
as much prostrated as topers when their 
drams are cut off. This is also true of some 
patients with the varied forms of tuberculosis. 
Vegetable foods made up chiefly of starch 
and more or less sweet juices will ferment 
after eating, especially when eaten raw, which 
arises partly from the fact, frequently proved, 
that both alcoholic and vinegar yeast abound 
in and on the skins or tegumentary covering 
of such vegetables. Cooking destroys these 
yeasts, which is one reason why cooked foods 
are as a rule more digestible than raw. 

It should be said here that perfectly fresh 
fruits, plucked from the plant, are much less 
fermentable and of course more easy to digest 
than when long removed from the source of 
growth, — all housekeepers know that freshly 
picked vegetables are the best. I once knew 
a farmer who would gather green corn in the 
field, and after a keen run would deposit the 
ears in boiling water prepared by his wife, 
and cook only a few minutes, whereby was 
obtained a most palatable, delicious, deli- 



8 4 

cately cooked, and extremely digestible prod- 
uct. I think it would be better to steam 
the maize where it grows. Even thus half- 
cooked, for canning it would keep for a long 
time (as does fish), preserve a fine flavor, and 
be ready to serve with a little more cooking. 
The principle seems to be that the heat of 
cooking destroys the peripheral and inter- 
stitial yeasts, so that the metabolic changes 
that fermentation produces in organic sub- 
stances are avoided; changes which culminate 
in the wilting and decay of plants and ani- 
mals when removed from their sources of life. 

Intestinal gases — hydrogen* sulphydric, 
phoshydric, etc.— arising from the fermenta- 
tion of meats are more poisonous than the 
common alcoholic carbon dioxide; they par- 
alyze more quickly and profoundly. Fibroid 
and sclerotic degenerations follow the action 
of these gases more readily than fatty degen- 
eration does. Meat dyspepsia is sometimes 
met with, and is to be treated by vegetable 
food and by nourishing enemata of animal 
food. 

The probabilities are that every vegetable 
and animal food has its own alcoholic and acid 
yeast. The botanical features may be alike, 
save as to size; but the protoplasm differen- 
tiates the products, as in cases of the epithelial 
protoplasm of liver, parotid glands, pancreas, 
kidneys, ears, and so forth. 

Another general principle of treatment is 
to quicken the circulation and thus quicken 
the functions that have been impeded or re- 
tarded. This may be done by employing 
quickening foods, such as hot water at the 
temperature of tea and coffee, one pint taken 



85 

by the mouth one hour before each meal and 
on going to bed, — distilled water is best, as 
it more readily dissolves out all impeding 
gravelly deposits found in the system, and at 
the same time quickens the circulation while 
removing mechanical impediments. Hot water 
causes peristaltic contractions of dilated stom- 
achs and intestines, thus removing paralyzing 
gases by belching or voiding; promotes peri- 
stalsis downwards and sometimes upwards, as 
lukewarm water does usually; dilutes the 
blood, so that it is less viscid and requires 
less force for the heart to propel it through 
the capillaries where the retardation of func- 
tions occurs, and whence is the very citadel of 
fatty degeneration. — This is a very important 
point! Consider that the average red cor- 
puscle has only one forty-eight-thousandth 
inch leeway in the capillaries, and that, on a 
modern estimate, the average human male 
adult body capillaries would extend in a 
straight line, if it were possible to place them 
end to end, more than 24,000 miles — i.e., 
around the earth! From this it is seen that 
the heart has no slight work in keeping up 
the blood circulation, no matter if the capil- 
laries average one three -thousandth of an 
inch in diameter; hence also may be inferred 
the value of hot water in lessening the work 
of the heart, and quickening the capillary cir- 
culation exactly where it is wanted. Hot 
water washes out the liver, which is a com- 
bined or compound gland, double if not triple, 
dense in structure, complex in architectural 
design, and secreting bile, which is one of the 
most viscid secretions in the body, the wash- 
ing out is so effectual that usually the faeces 



86 

will be stained black for more than six months 
after patients begin and continue to use it. 
The liver is specially liable to fatty degenera- 
tion, as it has normal fat-secreting epithelia, 
— the bile is full of cholesterine and other 
fatty bodies, — and its canals are tortuous in a 
somewhat inelastic histological environment. 

Probably the good of the hot teas of our 
grandmothers, and of the ptisans of the 
French, is due more to the hot water than 
to the herbs, because the former, employed 
without the latter, has been followed by 
equally good if not better results. 

The use of hot water in colds shows how 
it quickens the circulation. A "cold" is a 
very complicated matter, but it is enough for 
the present purpose to say that the blood is 
driven, by the "cold" contracting the capil- 
laries of the surface, in and on to the air 
passages, as a general rule perhaps, because 
they are so much exposed and have no rest 
from their indispensably vital and continuous 
work. Congestion follows and the circula- 
tion is impeded. Now if, in the pre-stages 
before the plastic products of inflammation 
have been poured forth, hot water is copiously 
drank once an hour, or oftener, not only does 
it warm the chilled outside surface, but the 
inside also The dermal capillaries are di- 
lated; sweat is organized by the epithelia of 
the sudoriferous glands, urine is voided in 
increased amount; the internal congestion is 
relieved (unless too long and firmly seated, 
and the tissues are on fire with inflammation, 
and even then the hot water comes not 
amiss) for one reason because there is not 
blood enough drawn from the rest of the 
system to keep up the congestion. 



87 

Hot water is not a dangerous remedy, as 
some aver positively, unless one is immersed 
in it; neither does it parboil the alimentary 
canal, or produce ulcers as some have alleged, 
on the strength of an experiment whereby 
hot water was injected into the stomach of a 
dog and produced ulceration. Swallowing, 
however, is not injecting; and I have seen 
ulcers of the stomach, but they were not in 
hot- water drinkers. 

From the prevalence of gravelly diseases, 
as rheumatism, asthma, gout, and urinary 
calculi, which impede circulation and thereby 
predispose to fatty ills, it would seem as if 
people did not drink enough water to keep 
the body salts in solution. It is not reason- 
able to expect gravels to be deposited when 
there is water enough to hold the saline 
bodies in solution, nor fatty degeneration to oc- 
cur as commonly as now. Again, the crema- 
tories show that a very large part of the human 
body is made up of water in organic combina- 
tion; it is also shown in the destruction of 
dissection subjects by desiccation. It may 
therefore be insisted that a large supply of 
water is needful for normal human life. 

To sum up, if it is desired to quicken 
the circulations of blood, chyme, glands, ali- 
mentary canal, osmosis, nerves, so as to keep 
the body systemic, literally in good running 
order, use hot water plentifully. If one is 
cut down to only one resource in disease, he 
should by all means hold on to hot water, 
which alone has cured cases irresistible to 
other treatment. 

Another quickening food is beef, because 
the heart so promptly responds to and is so 



88 

greatly strengthened by it It is unnecessary 
to increase the frequency of the pulse in 
order to increase the force of the circulation, 
but it is necessary to increase the power of 
the heart without quickening the beat. — The 
vernacular expresses this idea in classing 
beef as a " hearty" food. If people, instead 
of being afraid of "hearty" food, would use 
more of it, thereby strengthening the heart, 
the prevalence of fatty ills and their mas- 
querades would be greatly obviated. Next 
to beef come mutton and lamb; next eggs 
(especially the whites), game, codfish, fresh 
lobster, scallops, clams. But beef is the best 
of all to quicken a retarded or impeded cir- 
culation, which is the main aim. 

Another general principle in the treatment 
of fatty ills is the conservation of vital force 
or dynamis, so as to have more power to run 
the body machinery and functions. All 
schools of medicine adopt this principle, no 
matter what they profess to do or teach; for 
all inculcate rest, and the human body is 
ever manufacturing and storing force while 
at rest. It is so also with animals. Study- 
ing teaming on a high ridge where there 
is heavy travel; the hill is so steep and some- 
times so muddy that loaded teams often get 
stuck. Wise teamsters in such cases simply 
pause at the foot of the hill and give them- 
selves and teams a longer or shorter rest, 
whereby nerves and muscles are getting rein- 
forced and are storing up dynamis. After 
a little the teams carry the load. This shows 
that force is acquired from the food in the 
body all the time. If not, how could such 
rest help? It must be that our bodies are 



8 9 

storage batteries that accumulate power from 
within, power which can be so used up as to 
cause a stasis of functions. The horses in 
question could be driven to death, as some 
people drive themselves. 

Now when the functions of the body tissues 
are so impeded as to run into fatty ills be- 
cause of the loss or waste of force, what more 
sensible way is there to obviate than by rest ? 
Rest — from toil outside the body, as on Sab- 
bath days; from toil inside the body in the 
functions of life, repair of waste; by the use 
of easily digested food; by assuming a recum- 
bent posture, where the heart does not have 
to lift a haemostatic pressure of a column of 
blood the height of the body; by relief from 
the tight ligations and environments of 
closely - fitting clothing, as garters, corsets, 
waistbands, boots, shoes, collars, ill-fitting 
suspenders, trousers, waistcoats, etc.; by 
being in one even temperature in bed, when 
a standing posture gives a difference of 15 
F. between the head and feet; by relief from 
the cares and anxieties of business, work, 
worry, or pleasure; by having the body lie 
on the largest possible amount of surface; by 
being relieved from the weight of the body 
on the feet; by rest when tired out and the 
body is as it were cannibalized by consuming 
its own capital and reserve of capital. All 
these savings in the expenditure of life force 
accumulate a large power to run the func- 
tions, which were degenerating, it may be 
into fatty ills; Nature, having thus saved 
force, uses it to stop the fatty ills. 

What is life but a question of expenditure 
of vital force ? What is constitution but the 



9 o 

force conferred at birth, with which to run all 
our organs and tissues in our life-work, and 
which is ample if wisely expended? How 
can the constitution be saved better than by 
proper exercise and rest? All schools of 
medicine commend the conservation of force 
by sending patients to bed, withdrawing them 
from all abstracting and distracting influences. 
Note that sick cats and dogs, as well as many 
other animals, curl themselves up in a corner 
or some snug retreat, and after awhile re- 
cover health, simply by saving force for Na- 
ture to repair with ! 

But it will not answer to rest all the time; 
some exercise is necessary; many a fine 
horse has been ruined by idleness — fatty de- 
generation from high feeding and disuse. This 
statement covers the ground, as it is easy to 
understand how exercise would have pre- 
vented the fatty ills. 

Exercisal motions promote the circulation 
of the blood, and of the osmotic movements 
connected with nutrition, the proper organi- 
zation of glandular secretions, downward per- 
istalsis, to name no more. If the sufferers 
from post-partum convulsions had been 
obliged to do housework during pregnancy, 
they would probably have escaped acute fatty 
degeneration. How often do active business 
men, retiring after the age of sixty, and do- 
ing nothing, die from fatty ills ! It is a great 
art to know how to grow old gracefully, and 
to manage prophylactically to have exercise 
enough to avert fatty degeneration. 

Exercise for the fattily degenerated must 
be managed with care. Usually such persons 
exercise with gusto at first and take hold 



9i 

with vim, but soon the fatty heart shows 
signs of weakness; if the movements are vio- 
lent and prolonged, the heart will sometimes 
fail, and death ends the case. Such should 
be cautioned to keep strictly within their 
strength limits, and to stop at once all exer- 
cise the moment they observe weakness. 
Hence all competitive physical or mental con- 
tests must be avoided by the fatty ill, who 
should recognize their limitations by their 
own cerebrations. 

The following remarks on "Aids to Lon- 
gevity " from The Hospital (London) shows 
the difference of climate adding years to life 
by a light and dry atmosphere; one has only 
to pass a winter in London to appreciate the 
significance of this quotation; for the atmos- 
phere of this city is very depressing when the 
fog is so thick at 10 a.m. that the street gas- 
lights are kept burning. — It should be re- 
membered that apparently small causes tell 
for good or bad in those who are advanced 
in life — the very time for fatty ills: 

There are two sorts of pressure that tend to 
shorten life: Blood pressure within, and: Atmos- 
pheric pressure without. The latter is an espe- 
cially important factor in a humid climate. In 
advancing age the circulation of the blood and 
lymph tends to become slow, and the enfeebled 
(fatty) heart finds its embarrassments increased by 
this condition. Especially do the more vascular 
organs, such as the lungs, the liver, and the kid- 
neys, put skids on the wheels of the blood circula- 
tion.* Plainly, then, an important condition of 
cardiac easement, and therefore of life prolonga- 
tion, is the maintenance of an uncongested state of 



*That is, the conditions of fatty degeneration 
are set up. — C. 



9 2 

lung, liver, and kidney.* Thus are internal pres- 
sures relieved and thus is cardiac energy con- 
served. Of almost equal importance, at any rate 
in Great Britain, is the question of atmospheric 
pressure and moisture to aged persons. Situations 
which are at once low-lying and damp give of 
course a maximum of atmospheric pressure. Such 
a pressure weighs down at a single stroke body, 
mind, and life. The difference to aged persons 
living at the sea level and five hundred feet above 
it, between living in a moist atmosphere and living 
in a dry one, is sometimes quite incalculable. Not 
seldom may life be lengthened five or even ten 
years by living in an atmosphere both light and 
dry. These physiological considerations are com- 
mended to the aged, and to the physicians of the 
aged. 

In other words, the excessive atmospheric 
pressure retards the circulations and predis- 
poses to fatty ills. 

Again there is the psychological stimulus 
of ideas. In law and war mind often molds 
results; in murder trials the intent convicts. — 
General Grant commanded with the idea 
that war meant kill or be killed. Those who 
treat fatty ills must understand that it is a 
fight for life, and the patients must kill or be 
killed. 

My wife's brother was one of the Ninth 
Massachusetts Battery, which withstood the 
famous Pickett charge at Gettysburg, with 
sixty out of eighty men killed, wounded, or 
missing, and sixty out of eighty-six horses 
killed, wounded, or missing! He states that 
he was so inspired that he felt no fear, could 
calmly dodge cannon-balls as they came, and 
was not moved when one took off the head 
of a comrade next him! This admirable 



* Favorite seats of fatty ills. — C. 



93 

courage is paralleled when patients, away from 
the excitement of battle, stubbornly fight for 
life with fatty ills for weeks, months, and 
years. Their wills are determined to kill 
the disease, and these wills stimulate the life 
forces of soul and body to victory. I have 
seen a patient with Bright's disease die when 
there was no will to fight it, no confidence in 
the physician, and no pain to stimulate to 
action. The most difficult cases to handle 
are those which correspond to conventional 
(I am sorry to say it) professional ideas, that 
teach the shibboleth "No pain, no disease," 
which is about as sensible as to affirm that 
there is no light where there is no eye to see; 
as if the effulgence of the sun was caused by 
organs of sight! Destroy all eyes in the uni- 
verse, the sun would shine the same. 

Will is not everything, however. A widow 
with children nearly grown was a faith- 
curist. Her oldest son awoke one morning 
with fever, sore throat, and insisted he should 
stay at home, as he was too ill to work. 
"Oh, no," replied the mother; "go right 
along about your business, and it will get 
well of itself." He went, and the next day 
died! 

There is no doubt much useless expendi- 
ture of force by worrying— force which if 
conserved might often save the sick. But in 
fatty ills the cure takes much time, and as 
one well puts it, "Not only must the physi- 
cian believe, but he must make the patient 
believe in the treatment and bend all ener- 
gies to the work." Force is lost by not hav- 
ing the confidence which inspires faith and 
hope, and, to repeat, this very force may be 



94 

just what is needed for the cure; when this 
is so, then the cure is lost by lack of this 
faith, and hence the great value of the stimu- 
lus of ideas. This principle works even with 
medical men. A young physician settled in 
a place I had recommended, but he proved a 
failure. Afterwards he told me of it and 
related his first medical experience. A 
wrong diagnosis he arrived at, and so sent 
for aid, in consultation, to the a old doctor/' 
who was of course a rival and regarded him 
as an intruder. There was no trouble with 
the case, and it was safely ended. Said 
the young doctor: "I made up my mind 
beforehand that I should fail!" His after 
history was sad. He drifted from his pro- 
fession into keeping a candy and tobacco 
store; and when I tried to help him he 
said it was "of no use;" he finally suicided 
by opium. The moral of these things is that 
if doctors and patients go to work with the 
idea to have fatty ills kill, death must follow 
as a general rule. This was so in the case of 
a very old lady years ago in my father's prac- 
tise. She sent for him in her fatty ills, saying 
that she "was going to die this time sure!" 
"But," said he, "you pulled through before." 
"I don't care, I shall die," she replied, and 
she did ! It is not generally advisable to 
undertake cases where they have no will to 
get well, nor to do as they are told. When 
the will flags, confidence may be retained by 
telling historical truths about the case, even 
though they may be unfavorable. Then, 
when the reports are favorable, they will be 
much more satisfactory, because it is known 
that the truth has been told and can be de- 



95 

pended upon. This is a nice ethical point to 
handle in critical cases of fatty ills; as oil, 
albumen, casts, fatty epithelia, precede the 
feeling of malaise and illness, and should be 
removed before the soul failure. 

It is bad when the patient loses confidence 
in his or her physician. Were it not that 
people have faith in God and meet together 
to get comfort from His worship, and from 
one another, the direst results would follow; 
the terrible fear that would replace this faith 
would cause deaths. History relates how, in 
ancient times, when a walled city was be- 
sieged and thought to be taken, the milk in 
a matron's breast was poisoned, so that her 
suckling perished at once. On March 19th, 
1894, a woman with a seven months' babe 
had a mouse run up inside her skirts, which 
frightened her very much, and the child, 
never before ill, dieting solely on mother's 
milk, was in consequence ill all night with 
colic and diarrhoea! 

I can personally testify that going to a 
prayer-meeting is a very good way to gain 
strength and to banish a distressed and 
troubled state of mind, for it literally fur- 
nishes strength to the weary soul and body. 
On these principles a level head and deter- 
mined spirit will inspire hope, so that crises 
in fatty ills will be successfully met with which 
otherwise might prove fatal. 

Another form of treatment of fatty ills is 
by the conference of force or dynamis. In 
King David's time of fatty ills he married a 
young wife, Abishag; "But he knew her 
not," — she was specially to impart vital 
warmth and force. Thus "conference of force" 
was understood 10 15 B. C. 



9 6 

When the woman with the twelve years' 
issue of blood touched our Saviour's garment's 
hem from behind and was healed, he turned 
and said, "Who touched me? . . . for 
the virtue {dynamis) has gone out of me." It 
was a conference of divine dynamis. 

In 1873 I lay abed one hundred and ten 
days with a fractured patella. Friends and 
patients came to do something for me. I 
suffered greatly, and as anodynes amounted 
to nothing I asked them to rub the well knee. 
This done the pain would entirely subside in 
the fractured knee! Years elapsed before I 
understood that the relief afforded was by the 
conference of force. 

It was said of the elder Pitt that none 
could come in contact with him in his cabi- 
net without going away feeling stronger than 
before. A member of the British Medical 
Association present at the Leeds (1889) 
meeting reports that on his way home he 
met a large concourse of people surrounding 
a man who was lauding the wonderful cures 
he could perform very quickly of chronic 
diseases. He was using all the arts of bar- 
bering, livery stabling, jewelrying, oratory- 
ing, and tailoring. His hair was trimmed 
and dressed to perfection; he had equipages 
of striking magnificence; he was perfectly 
resplendent with gems, jewels, and gold; and 
was tonguey and eloquent. The medical 
man says further that in response to earnest 
invitations a large, heavy man hobbled in on 
crutches, evidently with great effort and 
much pain; he was assisted upon the stage 
and partially disrobed. The brilliajitly daz- 
zling healer then proceeded to rub him 



97 

vigorously, and kept it up with energy for 
twenty minutes, when the cripple got up with 
ease, walked off crutchless, and said he was 
cured ! The rubber was all of a heat and 
sweat, tired out from his exertions. Now 
the medical man said that there was no 
doubt of the cure, but that he could not see 
clearly the modus operandi, and asked for an 
explanation. I give one. Allowing there 
was no humbug, nor hypnotism, nor decep- 
tion, for the sense - striking environments 
strongly savor of the surroundings of jug- 
glers, who make no secret that they deceive 
the senses of observers, or hypnotize the 
audience, it seems that the healer conferred 
force or dynamis, which bridged over the 
patient's lack of it; the active or passive 
movements helped as in massage. Thus I 
have myself many times relieved the severest 
neurasthenic pain by simply laying on hands 
without movements, and conferred force. 
Hence I am inclined to explain this and 
other reported similar cases as instances of 
conference of force. 

Such methods do not always work. The 
late Judge Billings, of New Orleans, told me 
how his brother-in-law, sick with fatty ills, 
received a visit from a doctor in New York, 
who came in a six-horse chariot, with all 
fashionable appointments, and received $300, 
but no good resulted. 

I have often seen my father take an 
eighteen -months -old, teething, cross, crying 
and restless babe from the arms of its mother, 
when it would immediately quiet down and 
go to sleep! Twenty years later this was ex- 
plained to me simply by the facts the tired- 



9 8 

out matron had no force to confer (more 
likely she withdrew force from the babe), 
and my father being rested at once passed 
his force to the infant. I think that the suc- 
cess of practitioners depends somewhat on 
the quality; and no matter how little or much 
they know, they impart force to the weak, 
who are better for it, and hence feel the need 
of such physicians, This may explain the 
success of those with whose principles one 
cannot agree. 

In its special application to fatty ills it is 
easy to see how conference of force will 
quicken the circulation and other functions 
that have been impeded or hindered. Oste- 
opathy, which it is claimed cures thousands 
annually by manipulations of all sorts of con- 
tacts of strong persons with the patients, 
must confer force and thus account for its 
recoveries. Also I think that the secret of 
massage lies in the conference of force more 
than in the physical and mechanical results 
of manipulations. 

Again, may not Sir Humphrey Davy have 
had this power? It will be recalled some- 
where about 1800 A.D. it was thought that 
the newly discovered nitrous oxide gas would 
cure everything, and Sir Humphrey went to 
Guy's Hospital, London, to administer it to 
the haemiplegic as an experiment. There 
was a good amount of paraphernalia and 
preparatory arrangements; it took some time 
to fix the apparatus and make the gas in the 
ward by the patient's bed. When all was 
ready Sir Humphrey placed a thermometer 
under the patient's tongue. When the record 
of temperature was taken and the thermome- 



99 

ter removed the sick man, deeming he had 
received the treatment expected, remarked 
he felt "very much better." Sir Humphrey 
at once took the cue and said, "Well, that's 
good; we will come to-morrow and make a 
second trial/' This was done, repeating all 
the details as before. The third time the 
paralysis was cured. 

It is quite certain that force is used up 
in massage; this was shown in the exhaus- 
tion of the peripatetic healer aforesaid. I 
have had my right hand weakened and par- 
tially paralyzed for a fortnight by laying it 
too much and too long on a neurasthenic pa- 
tient. Also I knew a masseur who rubbed 
so many patients one day that he suddenly 
died. 

There is some stimulus from massage as 
in statical electricity; the circulation is ad- 
vanced in the capillaries and veins; adhe- 
sions are torn up; the blood is drawn to the 
surface, rubbed, and so forth. 

If, as some claim, there is animal magnet- 
ism evolved in massage, then it must at the 
slightest contact go through the body like 
electricity, making a short circuit. Be this 
as it may, I have no quarrel with masseurs; 
they all claim to stimulate impeded and re- 
tarded circulations, whether of blood, lymph, 
nerve force, or osmosis in cell biology: and 
this is what we are after in the treatment of 
fatty ills and their masquerades. But so 
long as masseurs magnify their ideas as to 
belittle the medical profession, it is well to 
know the exact standing of massage. 

A distinguished elocutionist discarded edu- 
cated physicians and employed a masseur for 



lOO 

everything; and the latter undertook even to 
relieve retention of urine by rubbing. Think 
of the agony induced by a distended bladder 
massaged for two or three days! Finally, a 
physician was called who catheterized him 
successfully, but too late to avert death! 
Had this savant lived in Japan three thou- 
sand years ago he would have had a better 
chance of relief, for Japanese catheters three 
millenniums old have been exhibited. One 
of the best ways to break up perverse and 
obstinate wills that are reasonably insensible 
to persuasions and commands is the use of 
the whip or nursery slipper, which are exag- 
gerated forms of massage, certainly revulsing 
sensation and withdrawing blood from the 
congested centers of thought which make the 
trouble! Indeed, reasoning in this way when 
our children were young, I persuaded my 
wife if they got into obstinate " tantrums," 
with head hot and flushed and face red, the 
application of cold water to the head would 
be preferable to the rod or slipper, because 
it would cool off the heat and drive away 
more quickly and safely the cerebrally con- 
gested blood. It proved so; .for the cold 
water no sooner cooled the head than the 
child was manageable. Evidently the effect 
was due to the force saved by the relief 
afforded to brain congestion. But this stim- 
ulation does not fully apply to the treatment 
of fatty ills, where there is a loss of power 
due to inherent tissue destruction and weak- 
ness. The whip, as once suggested by a 
patient with Bright's disease, was not applic- 
able, on the principle that it is useless to 
kick a dead dog with naught to respond to 
the impetus! 



IOI 



The good conferred by massage in fatty 
ills must be in the conference of force upon 
the disturbed processes of laying down and 
taking up tissues (metabolism), so that they 
will go on normally, and so that healthy tis- 
sues shall take the place of fat. This will be 
done, provided aliment is furnished that af- 
fords normal amounts of nutritive substances 
which can be assimilated, taken in, and laid 
down with a minimum expenditure of vital 
force, provided that there is dynamis enough 
to "run the machine." 

A regard to this principle would render 
massage even more useful, unless the idea is 
to live in physiological sin, and have masseurs 
to help pull the sinners out of their sin only 
to fall back again, and so on. This doc- 
trinal principle is not yet received, but I am 
convinced of its truthfulness and hopefulness 
from my own experiences, which I cannot 
ignore or deny. 

Heat is a form of motion which has been 
long universally used as a remedy, simply 
because it has been found to be immediately 
good. It is easy to see its applicability to 
the treatment of fatty ills. None would think 
of such a thing as applying cold to a part 
whose vitality is diminished, and whose circu- 
lation is retarded and impeded; nor of allow- 
ing the body of a fatty-ill patient to remain 
cold, because the latter aggravates the causes 
of such ills. Nor should the application of 
sweltering heat be employed, because of its 
nerve depression, such as is seen in sunstroke. 
These statements are truisms; but it seems 
that, when we have systemic loss of motion, 
the imponderable, colorless, invisible yet 



102 

measurable form of motion which we term 
heat should be mentioned among the other 
means for restoring normal biological motion. 

It has been said that "Heat is life and 
cold is death/' and the Thompsonian system 
of medicine was founded on this principle, 
and patients treated with natural and artificial 
heat. Capsicum was greatly employed be- 
cause it is "so heating," meaning that it 
confers motion and emotion (pain) ; but this 
principle being applied where there was no 
dynamic potential force, it entailed useless 
suffering. Fatty ills require more force to 
be added, not removed. 

Air should be fresh and pure, for hygiene 
has its place in the management of fatty mal- 
adies. Living rooms should be well venti- 
lated, and warm, but not hot. Mountain and 
sea air often quicken the circulations, redden 
the cheeks, and confer a peculiar sense of re- 
freshment to the whole body, and the millions 
of dollars spent each summer and winter in 
ocean travel, hotels, sanitaria, yachts, and 
steamships testify to the value set upon fresh, 
pure air. Would that the like estimate were 
set upon good air at home! Too often the 
ill are deprived of it for fear of taking cold, 
or as if it cost a dollar per cubic yard! In 
the sluggish and impeded circulations and 
functions of the fatty ill, there is no danger 
of taking cold by ventilation with proper 
management. Suppose extreme cases sick in 
bed: With such I have been in the habit, in 
city or rural districts, summer or winter, 
night or day, rain or shine, of ventilating and 
affording great relief by throwing a light 
shawl over the patient's head; by opening 



™3 

every door and window wide; by letting the 
air be changed in one or two minutes; and 
then, closing the doors and windows, uncover- 
ing the face. This process can be repeated 
at will, and it does not chill the room walls. 
The airing can be accelerated by half-open- 
ing a door and swinging to and fro from right 
to left in moderate time, when there is no 
wind and when there is a damp, stagnant con- 
dition of the atmosphere, and the air does 
not seem to move, especially from the cul- 
de-sacs and corners of the room. Beds 
should be thoroughly aired through the day, 
and made up at night, if the patient is up 
during the day. Day clothing can be aired 
at night, and night clothing aired in the day- 
time. The refreshment found in thoroughly 
aired clothing is such as is felt on changing 
a soiled shirt for a clean one, and is material. 
This leads me to speak of the hygiene of 
the skin. The skin is a sewer twenty-five 
miles long, if, as there is reason to believe, 
the corkscrew ducts of the sweat glands are 
correctly estimated to be of this great length! 
What with sweat, fat, scaly epithelia, foreign 
substances, as dirt (and the morphology of 
clothing and air), the skin becomes clogged 
and does not perform its functions, which are 
more or less vicarious of the functions of the 
internal organs. When the skin is kept clean 
by baths and well ventilated clothing, the sys- 
tem runs with less friction. Every one doubt- 
less has noticed a much better feeling after a 
bath when tired, worn, and in need of ablu- 
tion! Strength is conferred by thus saving 
it. The fatty ill need this more than the 
well, because the skin has more to do on ac- 



104 

count of the weakness of the kidneys; for 
them warm baths are better than cold, which 
may harm fattily degenerated tissues by 
shock. When cold baths are not followed 
by a healthy reaction they should be avoided. 
I will here relate a curious case of small kid- 
neys unable to be sufficiently vicarious with 
the skin; 

A child at the age of six years almost died 
from scarlet fever. In her girlhood she lived 
much out-of-doors like boys, and her ruddy 
face looked as if she were the incarnation of 
health; her laugh was so hearty that some 
said they would go miles to hear it; yet she 
had a great antipathy to baths of any kind, 
even salt water seaside baths. In my mind's 
eye I can see her as she appeared on one 
occasion at Swampscott beach, refusing to 
bathe with the family, and how her mother 
and aunt on either side forced her to the 
water and put her in despite her loud 
screams, tears, and entreaties. Her distress 
was so great that her bath was given up! 
The same thing occurred at home with ordi- 
nary baths. Sponge-baths she could take. 
This unusual antipathy was an engima until 
she died at the age of thirty - two. Her 
death, as shown by autopsy, was from cere- 
bral haemorrhage filling the right ventricle, 
causing hemiplegia of the left side of the 
body. Her memory was not lost. There 
were fatty heart, fatty liver, with fatty tumors 
embedded in the hepatic substance; fatty 
kidneys, which were of the size of those of a 
six years' child! It appeared that the kid- 
neys were arrested in their development by 
the scarlet fever, so that the skin was too 



large for the kidneys. When the functions 
of the skin were interfered with, by a cold 
sea-bath for example, the blood was thrown 
in upon the too small kidneys, which caused 
so much reflex trouble that the above distress 
was manifested and accounted for. But for 
this she might have sooner died. At any 
rate, if this explanation be thought unsatis- 
factory her case certainly proved the vital 
value of fresh, pure, outdoor air as a gaseous 
food. 

In 1888 while visiting at a stock farm out- 
side Louisville, Kentucky, my son, Doctor 
John A. Cutter, was consulted by a lady who 
for fifteen years had suffered from intolerable 
itching after bathing. She was the mother 
of several children; had nearly died several 
times from post-partum haemorrhage; her 
water was deeply loaded with bile; under the 
microscope crystals of cholesterine were found 
in the urine and blood. He put her upon 
absolute beef diet for a month, and then a 
more elastic diet was allowed; the urine 
cleared up, the symptoms of itching were 
controlled. Several years afterwards she 
wrote him that she had been in good condition 
and comfort, This was a case of fatty liver 
and fatty womb. 

Ammonia sponge baths—that is, two or 
more teaspoonfuls of aqua ammonia, according 
to strength, to one quart of warm water — are 
excellent, night and morning or both, in cases 
of fatty ills. It is only necessary to squeeze 
the sponge so it will not drip, rub over one 
part of the body, and wipe dry; next another 
part of the body; and so on until the whole 
surface is gone over. The glow and tingle 



io6 

which usually follow prove that the circula- 
tion in the skin has been quickened, and thus 
internal congestion may be removed. 

Turkish baths are well borne by some, but 
I think are not so good as the ammonia 
sponge-baths in these cases. Indeed, I was 
once called to a man who was supposed to be 
dying in a Turkish bath, His heart was fatty 
and had almost ceased to beat because of the 
shock of the bath; this leads me to say that 
hot tub-baths are agents of great biological 
power. The following cases prove this: 

A stout, healthy looking farmer suffered 
agonies from what appeared to be passage of 
a calculus through the ureter; was not re- 
lieved by opium and anaesthetics; but when 
submerged in a hot-water bath in less than 
three minutes he was relaxed and the agony 
relieved. The calculus was voided later. 

Another was a middle-aged woman with 
similar symptoms, to whom I was called in 
consultation. The attending physician had 
wisely exhausted the resources of drugs, and 
was willing to use the very hot bath as above. 
Immediate relief followed the relaxation 
thus induced. It has seemed to me that the 
fibrous structure was so relaxed by the hot 
water that its normal caliber of one-eighth 
inch allowed the passage of a stone one- 
quarter inch in diameter; or that the ureter 
was so softened as to give way under the 
tremendous pressure exerted by the combined 
epithelia of the kidney, whose protoplasm 
kept pumping urine into a pelvis blocked by 
the calculus in the ureter. If this seems an 
unwarranted deduction, I refer to the cele 
brated squash experiment of the late President 



io7 

Clarke of Massachusetts Agricultural Col- 
lege, in which some seventeen hundred pounds 
were lifted by the protoplasmic force of the 
growing cells! Also to the fact that I saw at 
Sonoma, California, in 1871, a champagne 
bottle whose neck had been squarely cut off 
by the inside pressure exerted by the proto- 
plasm of the yeast cells producing carbonic 
acid gas and alcohol — a dead lift, it was said, 
of one hundred and twenty-five pounds to 
the square inch. Again, my father and I ex- 
amined the corpse of a child two years old, 
dead of an obscure trouble in the abdomen. 
The walls of the urinary bladder were three- 
fourths of an inch thick, concentrically and 
wholly hypertrophied. Leading from the 
fundus of the bladder were two membranous 
tubes, of the same size and appearance as the 
small intestines over which they ran; they led 
to the kidneys, which were also greatly dilated, 
and proved to be the ureters expanded to 
this enormous size through the resistance 
proffered by the increased thickness of the 
bladder -walls and the consequent longer 
valvular passage through those walls. It is 
not improbable that the ureters were fattily 
degenerated, and it is a matter of regret I 
did not ascertain if they were so. The point 
is established, I think, that ureters can be 
dilated by intranephritic secretory protoplas- 
mic epithelial pressure. Indeed, is not this 
same protoplasmic pressure shown in the 
enormous enlargement of the sebaceous fol- 
licles of the scalp (when they grow as large 
as hens' eggs) filled with cholesterine? 

Water -baths should be used with judg- 
ment, not as cure alls but as useful hygienic 



io8 

measures, to go along with other means em- 
ployed to quicken the circulation and func- 
tions of cell life in cases of fatty ills. 

Electrical baths are useful, for they pass a 
current through the body systemic which is 
ill with impeded and slowed functions; not 
only this, but metals and reagents are now 
proved to pass through the body from one 
pole to another with electrical currents. 
When I was a medical student I met a man 
who showed his apparatus for electrical baths, 
and said he accomplished this transfer, but 
J. P. Cooke, my private chemical preceptor, 
did not believe it possible. I thought it might 
be so, but yielded to the superior knowledge 
of my teacher. Forty years later this was 
brought out as a new discovery in the pro- 
ceedings of the American Electro-Therapeu- 
tic Association. I, however, give the credit 
to my first informant. 

Dress should be comfortably warm, since a 
chilled body means more resistance to the 
functions and circulations of the fatty ill, and 
means more dynamis needful to run it. But 
we aim to need less force to run the body, 
and more left to cure with. It is work to 
live. It is work to run a normally warm 
body with its one hundred thousand miles of 
circulation ! It is more work to run this 
cold than warm. This difference may be all 
the difference needed for cure; hence dress 
warmly. 

Also dress loosely. I have hinted at the 
effect of ligatures and tight environments in 
producing fatty ills, and at the saving of 
force secured by having the body resting free 
from all girths and weights that compress and 



109 

weigh down the trunk and limbs; and I 
would reimpress the need of loose garments 
for the fatty ill. When I see a fat middle- 
aged lady girt with corsets so tightly that her 
waist is smooth and shining; that her breasts 
heave and palpitate with upper thoracic res- 
piration, when she should breathe by the dia- 
phragm and abdominal muscles; when her 
eyes protrude from pressure behind them, I 
think of a beetle in a vise trying to be an ant; 
of how the lady is, at the behests of fashion, 
only laying herself down as a sacrifice to fatty 
degeneration; that if there were a law — mu- 
nicipal, State, or national — thus to squeeze 
women by corsets, there would be a rebel- 
lion at once! Yet this invitation for fatty-ill 
immolation has been accepted by women for 
ages. I have volumes bound in parchment, 
of German inaugural medical theses, read 
and printed beautifully in the Latin language 
nearly two hundred years ago, in which one 
young candidate for medical honors bewails 
the fact that the ladies of his time would per- 
sist in wearing corsets no matter how much 
medical men opposed! I repeat this wail. 
While a few women are wise enough to abjure 
corsets, the vast majority do not, and they 
can moreover point to female physicians who 
endorse them, and some male ones also who 
have made themselves millionaires and so- 
ciety leaders by manufacturing and selling 
such goods.* 

Professor Louis A. Sayre has done the 
world vast benefit by showing the good of 



*Since this was written I have met the statement 
that women wore corsets 2000 years B. C! 



no 

plaster corsets for supporting diseased spines, 
but he always places a temporary bag over 
the epigastrium so as to leave room for the 
normal expansion of lungs and stomach. 

In my medical pupilage I saw taken from 
the body of a tight -lacing woman a fatty 
liver in which were left the marks of the 
supra-posed ribs, so deep as to leave perma- 
nent furrows with high ridges between. I 
asked the professor who exhibited it, "How 
could she have lived ?" He replied, " The 
Lord only knows!" 

Men advancing in age suffer, — I speak 
from experience. Tailors insist on a tight 
waistband to trousers; and when this is com- 
bined with a long, starched shirt-bosom there 
is a condition which is described in Acts* 
"where two seas meet." This meeting is 
over the pit of the stomach, where is located 
the solar plexus of nerves, called by the 
ancients "the abdominal brain," and it is a 
most sensitive spot. The result is that shirt- 
bosom and vest climb upwards and irritate 
the man, who naturally tends to fatty ills. 
His life is made uncomfortable by this ar- 
rangement, which invites these fatty ills. In 
the ordinary suspender the attachment to the 
waist is so made that the parts between the 
suspensions are drawn together; accordingly 
a properly measured waistband will become 
tight between the front and back when worn 
This I have relieved somewhat by a per- 
manent wire stretcher sewed in where the 
wrinkles come. If some one would invent 
suspenders that avoid this difficulty I am 



*Acts xxvii, 41. 



Ill 

sure old men would be much easier to get on 
with, and they would live longer. Cannot 
we have it the fashion to wear loose gar- 
ments that shall not impede the circulation 
and functions of the human body as we grow 
older ? 

Another principle of the treatment of fatty 
ills is to strengthen the heart. Granting that 
one cause of fatty ills is an impeded and 
sluggish circulation, it is plain that as the 
heart is the great kinetic moving power of 
the circulation, to strengthen it is an indica- 
tion special in its treatment. This can be 
done in two ways: By a special direct addi- 
tion to the heart kinetic energy, and; By 
diminishing the heart labor. The importance 
of this idea is so great as to excuse a repeti- 
tion of matters mentioned under other heads. 
Many good things in life are repetitions; for 
example, the beats of the heart, movements 
of respiration, eating, cooking, the love of 
home, friends, and country. 

Kinetic force may be given to a weak heart 
by feeding, and here beef stands in the fore- 
front; mutton next; game; codfish; poultry; 
shell-fish, as oysters, clams, lobsters; and 
other animal food — all of course properly 
cooked. The vegetable foods in their order 
of excellence are wheat, rye, barley, potatoes, 
tapioca, sago, string-beans, celery, apples, 
and prunes; vegetable food should not be 
eaten in a proportion <»f over one part by 
bulk to two parts of animal food. Of liquid 
foods, milk should be used sparingly, because 
of its fat. Coffee is thought by some to 
injure the heart, but more likely it stimulates 
a weak heart; still it is not a tonic like food. 



112 

The best authority I know of on this subject 
claims that coffee in moderate amounts does 
not injure the heart, provided that the other 
foods are used as indicated above. I think 
that coffee needs watching, and that it should 
be used without sugar, which does not 
strengthen the circulation, but often clogs 
the iiver and thus increases the heart work. 
Hot water directly strengthens, as has been 
shown before. 

Medicines, such as the pyrophosphate of 
iron, tartrate of iron and potassa, strychnine 
and its preparations (I like the sulphate, £$ 
to ¥ V of a grain at one dose), digitalin (^ 
grain); salicin and other like drugs must be 
looked upon as tonics for the heart. 

A weak heart may also be strengthened by 
diminishing its work in the following ways: 
By posture — to wit, in bed in the prone or 
supine position, where the circulation through 
ioo,coo miles of capillaries is made easier, 
because there is no head of blood to pump 
against: By postures that elevate the feet, 
thighs, and legs, or depress the head.* Per- 



*The writer has invented a chair on the prin- 
ciple of Professor L. A. Sayre's triple inclined 
plane, in which the head can be smoothly lowered 
almost to the floor, and the lower limbs correspond- 
ingly elevated; or the trunk may rest as if in a 
chair arranged like the letter V with an angle of 
45°, the head being at the top of one arm of the V 
and the feet at the top of the other arm of the V; 
or, as the chair has joints corresponding to the hip- 
and knee-joints, the legs may in this V-position be 
placed horizontally or at right angles to the hori- 
zon, or at any angle between. After the position 
is adjusted, turning an endless screw will throw 
the body-weight over the whole posterior surface 



"3 

haps the relief given to the heart by position 
with this device may best be told by the rela- 
tion of a case of hypertrophy and valvular 
lesion, where the fatty-ill patient had been 
for weeks unable to lie in bed more than half 
an hour at night because of dyspnoea. He 
was a man of sixty years of age; heart im- 
pulse felt over a larger area than normal; 
cardiac dulness on percussion increased in 
area; mitral regurgitation, orthopnoea, lower 
limbs swelled by the gravitation of dropsical 
fluid in the areolar tissues; anxious and dis- 
tressed looks; irregular pulse. He was placed 
in the chair in question so that very gradually 
and carefully his body assumed the V-posi- 
tion. The strain on the heart was so re- 
moved that after two days' sojourn in the 
chair — now resting on thighs, then resting on 
thighs and back; now resting on back, thighs, 
and legs, changing the position himself by 
the aid of the endless screw — he was able to 
lie in bed and sleep all through the night! 
For the rest of his life he slept in his bed. 
Had I then known of the relation of food to 
heart disease and fatty degeneration I think 
he would have had a good chance for re- 
covery, because he so quickly responded to 
the strengthening of the heart by mechan- 



of the body, thus relieving the thighs, which sus- 
tain the heat, weight, and burden of the body in 
ordinary chairs. Cases of angina pectoris, valvular 
disease of the heart, fatty heart, functional disturb- 
ance of the heart, etc., have been at once relieved 
from pain, from palpitation, and intermittent pul- 
sations with this device, and that too without medi- 
cine! President Garfield used this chair on the 
day before his death. 



114 

ically lessening its work. When hearts have 
shown signs of giving out, and I would have 
given diffusible stimulants, as Hoffmann's 
anodyne, alcohol, or hot water, the relief 
afforded by the above device has answered 
just as well, if not better, since medicines 
are not an unmixed benefit. 

It likewise diminishes the heart work to 
remove paralyzing gases from the alimentary 
canal; when the gases leave the partial paral- 
ysis ceases and the load is removed from the 
heart. To refer again to that hour of the 
night which proves so fatal to cases of heart 
disease, to wit, about 3 a.m., when the gases 
have accumulated during sleep so as to be 
fatal, because the paralysis was too much for 
the heart to carry: It is wonderful what 
simple means may be used to relieve this 
grave complication, one of which is the " lay- 
ing on of hands" of the patient, or better the 
hands of some one else.* Another means is 
to apply heat inside the stomach by drinking 
hot water; it is remarkable how quickly the 
distended stomach will contract and deliver 
the gas through the oesophagus. Probably 



* It is probable that there are foci of nerve force 
in different parts of the body. The force may be 
accumulated in one focus, rather than in another, 
and the application of the hands may restore the 
equilibrium and quiet disturbances. I have had 
an instrument made on this principle for uterine 
cases. With it I have seen pain in the head re- 
lieved, for example, by connecting a flat electrode 
on the head with one in the vagina touching the 
uterus. So it may be when the heart is fluttering 
weakly with paralysis from stomachic gases, the 
patient may convey force by laying on hands or 
rubbing. 



U5 

many of those dying from a fatty heart would 
have been saved by the free use of hot water 
combined or not with ginger or other aro- 
matics. — Cold water drank by some will 
eructate gas. Another way is to apply dry 
heat outside, which is better than wet heat. 
I like bags of dry, hot maize meal, for it is 
light, fragrant, and retains heat for a long 
time. Some use hot salt. Hops and aro- 
matics are good additions, but I think it is 
the heat that belches the wind. To show 
how hard it is to make this understood and 
practically useful to poor frail human nature, 
let me refer to a physician who was subject 
to heart disease: He intelligently dieted 
therefor, but at times he would " spree " on 
carbohydrate food. — He knew better, but he 
did it just the same; it was heart versus 
head, when the desires and feeling overcame 
wisdom and discretion. The result was that 
he died at about three o'clock one morning, 
his heart being overcome by stomachic gases. 
It was said that even he could have been 
saved if he had had on hand plenty of hot 
water to drink to start out the gas, and lessen 
the heart work. 

Another way to strengthen the fatty heart 
is to have Nature absorb the atheromatous, 
calcareous, or arterio - sclerotic bodies that 
weaken and diminish the caliber of the coro- 
nary arteries, besides causing the arteries to 
become inelastic tubes in place of elastic 
ones. When these deposits are removed there 
is a notable increase in the supply of blood, 
with better nutrition and easier work for the 
heart. The way to do this is to apply the 
principles here laid down, and Nature will as 



n6 

a matter of course remove these abnormal 
pathological products from any part of the 
body, provided she has time and proper ma- 
terials enough. 

As the heart is autonomic, and is the seat 
of passions and feelings, excesses of joy or 
grief, love or lust, anger or pleasure, sorrow 
or distress, will use up its force so that it has 
been known to stop suddenly and never re- 
sume its beats. Hence there is another way 
of strengthening the heart, negatively by the 
cultivation of calmness and repose, not being 
overexcited nor depressed; in other words, 
letting the head run the heart. Indulgences 
in overexertion physically, as in lifting 
weights, running up stairs or heights, and 
loud shouting, are liable to kill instantly those 
suffering from fatty ills, simply because there 
is not reserve power enough to stand the 
shock of the sudden demands made. Some 
years ago I observed that it required four 
times as much force to go up stairs as to go 
on a level at the same rate of speed. I was 
taken to task for underrating this effort, and 
a medical man of some experience declared 
it should have been stated "twenty times." 

Suppose a steam-engine is doing good 
work and this is suddenly increased fourfold 
(people go up stairs quickly as a rule), what 
would happen ? I asked this question of my 
brother-in-law, who has a three - hundred - 
horse- power Corliss engine, and he replied 
the engine would be smashed. In the light 
of this statement it is a miracle that people 
with fatty ills survive as long as they do. 
When they die we ought to rejoice that they 
lived as long as they did. 



ii7 

Light is an exquisitely delicate and almost 
unappreciably rapid mode of motion; without 
it man would die. It is a biological form of 
motion indicated in the treatment of fatty ills. 
Sunlight exerts a powerful influence on the 
growth of plants and animals; it affects the 
protoplasm of chlorophyll cells, and the cells 
of the cheeks and hands of mankind. A large 
book was once written on blue light as a 
medicine, and extravagant claims made for 
it; for example, water kept in a blue vial was 
claimed to be an excellent purge! I do not 
know about this, but I do know that it is a 
sensible thing to treat fatty ills with plenty of 
sunlight, unless it is too hot; and if people with 
fatty ills lived continuously out-of-doors I 
think they might prolong their lives. The heat 
that comes from sunlight is more refreshing 
than from other sources; it seems to quicken 
the circulation better, and that is what we are 
after. To impress the intense rapidity of vi- 
brations of light let me say that violet rays 
are said to have three thousand millions vi- 
brations per second, and that it takes seven 
years to count this sum at six thousand per 
hour, ten hours per day, and three hundred 
working days in a year! 

While writing this I have a patient with 
fatty ills who says he gets great benefit from 
sunlight coming through blue glass. He sits 
in a box, head outside, and only the side in 
front admits light through a blue pane of 
glass. His nude body sweats profusely from 
the heat. This proves an increased circula- 
tion, activity, and motion of the sudorific 
glands. But light does not take the place of 
proper feeding. 



n8 

A late writer states that light would not 
exist without eyes, or exists only in our eyes. 
I do not believe this, as I look on a green 
lawn illuminated by the sunlight. There are 
blind people, but their blindness does not 
put out the sun, which would shine if all eyes 
were extinguished forever. 

A student once said he was determined to 
find out what electricity was, but I doubt if 
he succeeded, since no one understands the 
unseen essence or the effects it produces — 
light, heat, motion, emotions, chemical ac- 
tions. The word is of Greek origin, meaning 
amber, because amber was first used to dem- 
onstrate electricity by friction; but amber is 
temporal, while the eternal fact, electricity, 
is invisible. 

I think it is a safe thing to say that elec- 
tricity is an ether and a mode of motion, like 
light and heat. It is not life, as some claim, 
because it is manifested by lifeless things 
coming together in unequal physical or chem- 
ical action; and though life has electrical 
manifestations, electrical manifestations are 
not life How electricity acts as a curative 
agent is a mystery; for instance, it is difficult 
to understand how electricity cures uterine 
fibroids; but this idea is impressed on me as 
I write, that possibly the wonderful varieties 
and adaptations of electricity may be useful 
as forms of motion in cases of fatty ills, where 
motions are impeded and retarded My for- 
mula is as follows: Life is made up of motions 
and emotions. Some diseases are caused by re- 
tarded or impeded motions. Electricity is a form 
of motion biologically penetrating Hence elec- 
tricity is a remedy for some diseases, 



ii 9 

Electricity pervades like space; some even 
affirm its presence in water makes it a con- 
stituted part of that element; but because a 
piece of copper and a piece of zinc touching 
each other produce electricity it does not 
necessarily follow that copper and zinc are 
made up of electricity 

As fatty degeneration of muscles is such a 
malevolent agent it is interesting to read that 
u the development of the muscles of the body, 
in a way other than by physical exercise, is 
made possible by the use of galvanism. A 
regular application of the electric current to 
any particular set of muscles in the body 
often results in their weight and strength in- 
creasing as much as forty per cent." 

The kinds or forms of differentiations of 
medical electricity are. Static, Faradic, and 
Galvanic. 

Doctor Robert Newman, of New York, the 
medical electrician, inventor of methods for 
electrolysis of urethral strictures, and a gen- 
tleman advanced in life, told me he had 
received the greatest benefit from static elec- 
tricity It is easy to see that sparks drawn 
out from different parts of the body must 
make these parts interstitially move as to cir- 
culation and functions, and on this account I 
think favorably of this kind of electricity in 
fatty ills. 

Faradic electricity, or the induced current, 
is the variety in general clinical use, but I 
have never been able to get much satisfaction 
from it. Twenty-five years ago the late la- 
mented Doctor Louis Elsberg, of New York. 
whose learning in physics and physic was very 
great, affirmed that when electricity did good 



120 

twenty times, the faradic current did good 
once, and the galvanic nineteen times. Im- 
mediately I chose the latter, for life is too 
short to waste nineteen out of twenty chances 
to do good with electricity 1 owe much to 
Doctor Elsberg for this dictum But it must 
be admitted the faradic is more popular, and 
an eminent electrician informed me he had to 
use it because patients were not satisfied un- 
less they felt the current This evidences 
the man who desires to succeed as a physician 
must study human nature, and there should 
be a course of lectures on the ethics of 
handling cases Nevertheless it is too bad 
the trailties of humanity should so interfere 
with its welfare that where nineteen cures 
should be had only one poor sufferer is re- 
lieved The history of clinical electricity 
would have been far better if galvanism had 
always replaced faradism ! Again, Terry 
d'Etoille, in 1876, asserted that the faradic 
current does not influence the unstriped mus- 
cular fibers, but that the galvanic does. Alt- 
haus reports the faradic current induces fatty 
degeneration of the striped muscular fibers, 
and he gives a drawing of such fibers through 
which faradic currents have passed, whereby 
they have mostly been reduced to fat glob- 
ules, with no semblance of their former struc- 
ture. Faradism acts only through the nerves 
to contract muscles. The moral of all this is, 
Do not employ the faradic current in fatty 
ills. 

Althaus also declares the galvanic current 
does not fattily degenerate the unstriped 
muscles, but strengthens them. Galvanism 
contracts muscles through the nerves, or, if 



121 



they are paralyzed, contracts the muscles 
without nerves! To repeat: where twenty 
cures occur by electricity, nineteen are due 
to galvanism; and acting on the foregoing 
principles, I use the galvanic current, and 
as yet have had no reason to be dissatisfied. 
The great objection, aside from its not being 
felt, is that alleged by those who have stood 
at the head of medical electricism, viz., 
that it has no power of penetration; but the 
facts are that in applying the positive pole — 
a gold needle — to a bony outgrowth in the 
meatus auditorius externus, the skin imme- 
diately assumes a deep red color that subsides 
on the removal of the electrodes; that when 
both electrodes are buried four to five inches 
deep in and through the abdominal walls, 
and a uterine fibroid and a voltameter is 
intercalated, the current traversing the tumor 
promptly sends the index needle to 1.70 
volts; that in a like case of galvanism of a 
uterine fibroid the pulse would fall to eighty 
per minute when the plates were removed 
from the solution, and that the pulse would 
rise in one second to ninety when the plates 
were reimmersed; that Professor H. M. Field, 
M.D., of Dartmouth College, who witnessed 
the latter, emphatically remarked he knew 
of no agent in the materia medica that would 
so quickly raise the pulse as was done by 
galvanism. The facts related form the basis 
on which galvanism is recommended for fatty 
ills; and I am more inclined to do this, since 
the process of cell and tissue nutrition ap- 
proaches galvanism in the minute movements 
of metabolism. Electricity must be present 
to all persons, since the frictions, motions, 



122 

and chemical actions of biology develop it; 
but some evince more animal electricity than 
others. The friction of winking my eyes in 
the dark produces flashes of light like a 
galvanic battery. Some think that electricity 
is everywhere present, hence the sparks that 
come from the body are the result of static 
electricity; others, that the earth is charged 
with it, from its intensely rapid motions of a 
thousand miles a minute in its orbit, and a 
thousand miles an hour on its axis, besides 
the intraterrestrial chemical actions, assisted 
by incandescent molten platinum, silver, gold, 
iron, and other metals making up the central 
mass of the globe. Be these things as they 
may, they do not annul the fact that galvan- 
ism clinically applied does quicken and pro- 
mote arterial, capillary, and venous circula- 
tions, which operation is a good remedy for 
fatty ills, well worthy of trial, but not to take 
the place of proper feeding, which is a sine 
qua non, 

A good mode of application is by baths. 
Neither is it necessary to have expensive 
electrodes. Silver spoons make good con- 
ductors, simply winding the connecting wires 
around the shaft, and if desired a sponge 
may be put in the bowl, held there by a silk 
thread. If a flat surface is sought, the handle 
of a tablespoon will furnish it. I usually em- 
ployed my own batteries, on whose rods and 
connections I spent much thought. Galvanic 
action is easy to get, but the great difficulty 
is to control and keep it by good connections. 
The common screw and socket is not as good 
as the cam connection, for in the socket contact 
is tangential, while that of the cam is flat sur- 



123 

face to flat surface; also the fewer connections 
the better. Platinum foil makes the best con- 
nection because it is not acted upon by the 
current so much as other metals. Sometimes, 
with all care, a battery will not work, and 
one cannot tell where the trouble is, but if 
allowed to rest over night it will generally 
work again. 

There have been many claims for elec- 
tricity which could not be sustained, never- 
theless it is an admirable agent, one whose 
therapeutic claims would hold better if it 
were not for the wordy and dogmatic asser- 
tions and commands of those who pose as 
"knowing all about it." I think I have a 
right to speak thus, as I too have been a 
pioneer and obtained, midst opposition if not 
reproach, results that have stood the world's 
tests for more than twenty years — results 
which were predicted to be impossible and 
postdicted as not having had an existence. 
From the close kinship of fatty and fibroid 
degenerations I am inclined to attribute the 
success of galvanism of uterine fibroids to 
the quickening and forwarding of the circu- 
lations, functions, and nutrition by the con- 
stant current, not excluding proper feeding 
nor the other auxiliaries named. I would 
recommend large plates for batteries, as giv- 
ing less pain than the small ones, or in other 
words quantity in place of intensity. Small 
and multiple cells give more pain and are 
more caustic. It is undesirable to break 
down the tissues in chemical necrosis directly, 
but one should so stimulate the circulations 
that nutrition will go on, and cease to lay 



124 

down abnormal tissue, whether fatty or 
fibroid.* 

Now regarding the use of galvanism in 
fatty ills: So far as possible it should be ap- 
plied to the local lesion. For the heart, one 
electrode may be placed on the prsecordium 
and the other on or under the back opposite. 



*Some practical points about making batteries 
galvanic. Any two different substances on which 
chemicals act differently in degree, which decom- 
pose differently, will do for a battery. In my 
pupilage I made batteries from layers of oranges 
and lemons separated by bibulous paper; also from 
beef and mutton. A zinc and copper battery, such 
as I would call No. I and run with water, will de- 
compose the same element. A good battery for 
fatty ills can be made of carbon and zinc plates, 
six by nine inches, with a glass tray or crock to set 
them in, so that they will not touch. Use a solu- 
tion made of saturated bichromate potassic or sodic 
water, and add one part of sulphuric acid to ten of 
the solution. Connect wires with plates. — A good 
way to make connection with the carbons is to 
plate them with copper; the wire can be then easily 
soldered to the copper plating and covered with 
paraffin. I have suffered because the workmen 
bored holes in the carbon, and filled the same with 
lead or solder to which to attach the binding posts 
It was a strong, nice-looking connection, but 
allowed little of the current to pass. It is well to 
have the cell shorter than the plates, as the con- 
nections are kept out of the solution, and there is 
less danger from the creeping of the salts My 
son, E. P. Cutter, has made a very light and good 
battery from arc-light carbons; a block of hard 
wood 3x4x2 inches, bored with holes near the edges, 
receives the carbons tightly, the tops of which are 
wound with copper wire, and soldered on for con- 
ductors; a stout copper wire is wound around the 
edge and fastened about the binding post at one 
end of the block, which makes a solid hold on the 



"5 

—The silver tablespoons used as electrodes 
easily slip under the clothing. For Bright's 
disease of the kidneys, put one electrode 
over the abdomen to either side of the navel, 
and the other electrode over the loins. For 
apoplexy, one electrode over the nape of the 
neck, and the other on the top of the head; 
this should be used with care, but common 
sense will make easy the details of the appli- 
cations; the more the quantity the better. 



carbons, which are eight in number and six inches 
long; the zinc plate is 6x3x^6 inches, and to its top 
is soldered a two-inch loop of copper wire whose 
ends run uppermost through the block, one being 
prolonged for connection; the cell is a glass bottle 
cut off at the top With such a battery carbon 
pole in vagina, and zinc pole on abdomen a myo- 
fibroid of the uterus, larger than a child's head was 
softened, reduced in size, and the uterine haemor- 
rhage entirely checked by a dozen applications of 
five minutes at night on going to bed. 

A large battery that I term No. 3 has about 
thirteen square feet of surface, and measures 
twenty-seven amperes: it is employed for uterine 
fibroids by the electrodes being plunged through 
the abdominal walls and the peritoneum. This 
operation sometimes succeeds with from one to 
four applications, but it is so severe that few dare 
to do it. Battery No. 2 has carbons |^x^x6 inches, 
zincs ^xf£x6 inches; the connections are strips of 
copper %xy£x2 inches long, which at the free ends 
are bent into a broad hook — as occurs in shaking 
hands. It is easy to separate the strips, polish 
them with sandpaper, and thus freshen their sur- 
faces. The convex surface of the hook prevents 
the dust from readily entering the contact. The 
cell is made of sheet lead, which fits close for pro- 
tection, and requires a new solution every time it is 
used for galvanic caustic. 

These details may seem to be out of place, but 
they have cost the writer much time and thought 
and have been valuable to him. 



126 

Says Professor Tarchanoff, of St. Peters- 
burg, who has been experimenting on the 
subject of music from a purely physiological 
standpoint; " It relieves muscular fatigue in 
man, helps to drive out carbonic acid in dogs 
and increases their consumption of oxygen 
and also makes them perspire." He thinks 
it may be regarded as a serious therapeutic 
agent. Now to apply this to fatty ills: Music 
is harmonious motion and causes forms of 
motion, invisible but sensible, as much as if 
they were visible. Severe toothache is an in- 
visible painful emotion which has no weight 
nor color, does not occupy space, but some- 
times causes motions of air that result in 
unpleasant sounds and has undoubtedly a 
real existence. Music is an enjoyable in- 
spirational pursuit, whether listened to or 
performed. It affects emotions Emotions 
affect circulations and secretions. Bad music 
is not enjoyable, and is productive of de- 
pressing effects unhelpful to the fatty ill 
with retarded and impeded functions. The 
effect of inspirational and enjoyable music is 
to quicken the functions, especially the circu- 
lation, hence it acts as a remedial measure. 

•' I always get warm when I play the piano," 
said a lady. Major military music quickens 
the blood and emotionally stirs the courage 
of soldiers. The boy who whistles when 
going by a graveyard at midnight inspires 
his courage. Music tones up the sympathetic 
and cerebral nerve centers, and thus facili 
tates their work. My father, the late Ben 
jamin Cutter, used to gently whistle to him- 
self when he had a perplexing case to treat 
Sailors sing when they do heavy work. The 



127 

soul is moved and then strengthened by 
music. A stirring, strong soul means better 
circulation of blood, lymph, and glandular 
secretions. Music revives the memory. There 
are some notable instances of this. Music is 
thought by some to promote longevity, and 
with good reason, since fatty ills, normal in 
old age, are dependent upon the flagging 
powers of life. Music should be expected to 
relieve those ills and thus keep off the in- 
firmities of old age. 

The Reverend Peter Kimball died at Perth 
Amboy, New Jersey, June 15th, 1892, and 
had he lived to March 5th, 1893, he would 
have been one hundred years old ! I visited 
him about two months before death. He 
was a small, spare, bright, affable person 
with iron-gray hair, not bald, not overstrong, 
though he had life enough to drum with 
regulation drumsticks on a bag of sand while 
I sang "Hail Columbia," but as I did not 
sing it fast enough to suit him he sang a 
military march and drummed away merrily ! 
He also played to me on the fife. He had 
drummed before the war of 1812! His 
memory was good for late and early dates. 
He could solve problems in cube root, and 
was more accurate as to his age than I was. 
He insisted that music was one reason of his 
longevity in the use of the fife for lungs, and 
drumsticks for heart; and I believe he was 
correct. Playing the fife pleasantly expands 
the chest, promotes the circulation of air in 
the lungs, hence gives more vitality to the 
body, and helps the retarded and impeded 
circulations; the drumsticks played, he said, 
would arrest the palpitations of the heart 



128 

when he was very ill therewith. — No doubt 
their music inspired him with its emotional 
force such as the heart needs at these crises, 
hence it is very probable he was right in his 
estimate of music and longevity, though there 
were other elements as remarkable: for in- 
stance, he had totally abstained from tea, 
coffee, and tobacco since 1830, and from rum 
since 181 7! Had he been able to obtain 
proper food it seems as if he would have 
rounded out a full century of existence! 
There was a sad side to this centenarian; all 
but a few of his kin were dead; he was sub- 
ject to petty annoyances and grievances, such 
as a cold, sunless room with a northern ex- 
posure; no bell or electric call; and he had 
other vexations which I in vain tried to re- 
lieve. But this does not blunt the point that 
music helped his longevity.* 

In 1888 Professor Dogiel published at Ka- 
zan, Russia, his experiments as to the effect 
of music on the circulation: Dogs were made 
insensible and an artery laid bare, a platys- 
mygraph then applied, and tracings made as 
by the sphygmograph; then other tracings 
were made during whistling and instrumental 
music, when the tracings presented heavier 
curves and markings. The same experiments 
were made on man by enclosing the right 
arm, forearm, and hand within a glass cylin- 
der filled with water kept in by a tight rub- 
ber collar about the arm. By ingenious dia- 
phragms arranged in conical receptacles the 
impulses of the heart upon the whole limb 



*See "Music and Longevity/' Scientific Ameri- 
can Supplement, September 16th, 1894. 



I2g 

were conveyed to a tracing cylinder, before, 
during, and after the performance of music 
on clarinets, flutes, violins, and whistles. The 
results in the heavier lines and increased 
curves were the same as in the dog experi- 
ments. Until these results are upset by some 
one who has repeated them in like manner, I 
think they should be received as proof that 
the circulation is quickened and increased by 
musical sounds acting on the nerves and heart. 
The relations of music and medicine have 
received considerable attention, and the liter- 
ature thereof goes far back into antiquity 
and is greater than one would suppose. In 
evidence of this statement I refer to young 
David employed to play the harp to allay the 
madness of King Saul. In the " Haven of 
Health," published in London by a school- 
teacher in 1579, music is put down as one of 
the remedies to be used to preserve health. 
The following extract is taken from " Dieta 
Literorum:"* 

Quid Musica In excitandis ac diversimode for- 
mandis animi commotionibus; his valeat in aprico 
est. Haec mentem componit; curas et tristiti 
pellit; labores lenit; Spiritus recreat ac excitat.f 

As evidence this subject is attracting at- 
tention, the fact may be cited that Canon 



*An Inaugural Thesis read by John Rotten- 
burger, January, 1724, Eighth Edition, 1729, Sec- 
tion III, Caput. Ill, page 25, under the head of Air 
for Literati. 

fThat music avails in exciting and in many 
ways forming (molding and controlling) the com- 
motions of the soul is clear as sunlight. It com- 
poses the mind; it drives away cares and sadness; 
It lightens labors; it recreates and rouses the 
spirits. 



130 

Harford of Westminster Abbey has under his 
care a St. Cecilia's Guild which offers music 
as a medicine to the sick in London; and I 
have in my possession a letter in which he 
speaks of the good work already done. He 
uses female voices. It has seemed to me 
that, as voices would be difficult to be had 
on call at apothecaries, phonographs could 
be prescribed, and these would give the right 
lullabys correctly, would play softly, and 
could be carried about by unskilled hands 
with but little trouble and less expense than 
skilled voices. If this part of my subject 
seems unpractical, still it is an argument for 
those who have fatty ills coming on to make 
use of all musical opportunities, for there is 
no doubt that music directly and indirectly 
relieves the diseased conditions so often re- 
ferred to here. 

But it should be remembered that not all 
that is called music would be useful as a 
medicine. There is music and music; also 
the standard varies with the individual: For 
instance, the late James G. Blaine, who died 
of fatty degeneration, hired hand-organ men 
to play before his house daily during his ill- 
ness; but if I were ill hand -organs would 
make me worse. The crooning of an Irish 
mother might soothe her own sick babe, but 
keep another one awake. Music played by 
artists, but with blaring horns drowning the 
strings of the orchestra, would be unsatis- 
factory. Canon Harford speaks of lullabys 
and anthems. I think that the andante and 
andantino movements of Beethoven's, Mo- 
zart's, and Haydn's trios for the piano, cello, 
and violin are the best classical music for 



131 

fatty ills. Such songs as "Annie Laurie," 
"Ye Banks and Braes of Bonnie Doon," 
" Those Evening Bells," and other soft, sweet, 
and low musical songs are to be selected. 
A fine music-box playing in the chamber of 
the sick is an easy way of testing the virtue 
of music for the ill; indeed, I would allow 
patients, if musical, to play on instruments 
of the violin class, the flute, etc. In walking 
cases, concerted music may well be utilized 
to accelerate the functions of their systems. 
Though fatty ills can be caused by such 
medicines as phosphorus in massive doses, 
there are none I know of which can cure 
them. Medicines have been well termed the 
"oils" for the sick body machine, to make it 
"run smoother." So far as this goes they 
are to be regarded as curative by increasing 
the circulatory functions. Good vegetable 
tonics may be resorted to. I like the com- 
pound prescriptions, and make use of those 
made from fluid extracts, though they can be 
made from good tinctures; of course the phy- 
sician should satisfy himself as to purity in 
either case. Here is one: 

9 Tincture cinchona compound, 3 ounces. 
Tincture gentian, 12 drachms. 
Tincture cardamom compound, 4 drachms. 
Liquor Sedans (without sugar, P. D. & Co.), 
3 ounces. 

From half a teaspoonful to one teaspoonful in a 
little water at meals. 

The above I have used as tonic in cases of 
fatty ills associated with pain; at my son's 
request Messrs. Parke, Davis & Co. made up 
the last item, composed of viburnum, dog- 
wood, and hydrastis, without sugar and with 



glycerin; it is better borne than the original 
liquor sedans. 

Salicin is a splendid tonic, a good digest- 
ive and antifermentative; it checks diarrhoea 
usually. Strychnia, too, is a very valuable 
medicine. 

But all of this matter of medicine must be 
determined by the special case. I could write 
much about Hoffmann's anodyne, sumbul, 
asafcetida, iodoform, pyrophosphate of iron, 
permanganate of potash, etc.; but the prac- 
titioner must work out the individual prob- 
lems before him. Some cases require much 
medicine; others very little. 

Regarding constipation: The laity like to 
push fruits and sweets to move their bowels, 
but the movements obtained in this way are 
at the expense of more or less intestinal fer- 
mentation, and are forced by an endeavor to 
get rid of gas and yeasts, while the constipa- 
tion is caused by lack of nerve force. Feed the 
patient by good food and the nerve force will 
come back and the machine start again. The 
chemically pure sulphate of soda often acts 
well; also small doses of fluid extract of cas- 
cara sagrada; and some cases need enemata, 
though I am as a rule opposed to frequent 
washing of the bowel, as it depletes the body 
by siphoning from the small intestine the 
nutritive elements about to be absorbed; only 
when the patient's large intestine is full of 
yeasts is it well to wash out the bowel care- 
fully, using some preparation, such as Euthy- 
mol, to kill the ferments. It is a good rule 
also to avoid apollinaris, soda, or other car- 
bonic acid drinks, for carbonic acid gas is an 
agent which retards and impedes the func- 



*33 

tions of the system by its direct and indirect 
paralyzing powers upon parts of the body 
near and remote. Olive oil and castor oil are 
not admissible because all fats promote fatty 
degeneration. 

When there is no principle on which to 
give medicines, then none should be admin- 
istered. Remember it is Nature who cures 
by her own powers of normal metabolism, 
transformation, transfiguration, or metamor- 
phosis; that medicines/^ se do not cure any- 
thing. But if Nature furnishes the dynamic 
force, actual and potential, for them to work 
with, medicines may be of value. 

Special obstacles should always be re- 
moved; that is, the obstacles that arise from 
peculiar constitutions and idiosyncrasies; 
complicating diseases and conditions should 
be obviated as much as possible. If there is 
constipation (excuse the repetition) it should 
be dealt with mildly, mildly, mildly, until the 
bowels are open. — If desired, proper pro- 
portions of rhubarb, cascara, or aloes may 
be added to the tonic aforesaid. There must 
be care in using salines for mild cathartics, 
as the trouble is that the fatty ill have gen- 
erally too many salts in them anyhow, and it 
is unwise to add to the burden. The treat- 
ment should aim to reduce all the body sys- 
temic salts to their normal proportions, and 
thus avoid clogging. Massage and the lay- 
ing on of hands will help constipation by 
conferring nerve force, a lack of which, in 
my judgment, is the great cause of constipa- 
tion. 

Again, all the blame because things do not 
go right must not be laid to the treatment, 



*34 

because lapses and hindrances often come 
from overdoing in worry, work, or pleasure, 
which use up the vital force {dynamis) needed 
to run the body normally. Many cases are 
upset because some great irremediable cause 
of grief comes to bar out or mar success; 
and so far as possible the physician should 
try to avert such cause or causes. It is a 
good plan to make patients confidants, and 
make them understand the medical attendant 
is working sincerely and earnestly (without 
deceit) to remove their fatty lesions, and 
that their help is of vital importance. It 
does good sometimes to show patients the 
abnormal morphologies — i.e., fatty epithelia, 
free oil, amyloid, and albumen. Physicians 
must be truthful, patient, persevering, firm, 
and labor in all ways to deserve and inspire 
mutual confidence. If the patients act as 
if their minds were reaching out or forth 
to some other treatment, it is best to settle 
this by pleasantly offering to relinquish the 
case. 

Sometimes it is well to make patients sign 
an agreement to be faithful for a certain 
length of time, say six months or a year. It 
is not enough to restore a condition of 
health, but the course must be persevered in 
to confirm the body systemic in the new 
ways of normal life. While there is evolu- 
tion in many things, I opine that the oppo- 
site, " devolution, " is oftener met with in the 
practise of medicine; in other words, patients 
are more liable to retrograde than to advance 
(evolute); hence patients must be looked 
after and a good deal of hard work put into 
the conduct of their cases. Energy and per- 



US 

severance are required as a rule to honor the 
medical profession by securing the best re- 
sults. 

The time has come when there should be 
a better understanding of the way in which 
cures come. Call the processes of laying 
down and taking up tissues, which are all 
the time going on in every living human 
body (sick or well), metabolism, transforma- 
tion, metamorphosis, translation, or anything 
else, nevertheless Nature is at the helm of 
all vital processes. 

But what is Nature? some one may ask. 
The word comes from the Greek verb gennao, 
to be born; "genesis" has the same root, 
and means birth. It implies origin from some 
power not inherent in itself, as a child born 
certainly comes from and represents, how- 
ever well or ill, its parents; the child could 
not exist had not those parents existed 
previously. In this era of the world it is 
consonant with time, names, and prevail- 
ing beliefs to assert that the power from 
which what is called Nature is nascent or 
born, is the Creator and Sustainer of the 
universe, "in whom we live and move and 
are." 

Celsus has told us that the operations of 
Nature in medicine are like those exerted in 
agriculture and commerce. Physicians are 
wont to declare they have "cured" a case; 
but they should say, "We have changed 
things in obedience to the law of gravitation 
and medicine, which have righted the pa- 
tient." 

Nature in surgery is equally essential. 
Take a simple cut of the skin. All that 



136 

the surgeon does is to care for the cut, bring 
the edges together, keep it clean by dry ab- 
sorbent cotton (if he chooses). Other things 
being equal the cut will heal through Nature's 
sending the leucocytes and pouring out the 
lymph, which she organizes into new connec- 
tive tissues. This is no more wonderful than 
Nature's repairs of wounded plants and fruits; 
for it is an inherent law of Nature to heal 
wounds if she has the wherewithal to do it 
with. On the first phalanx of my right fore- 
finger is a scar of a surgeon's cut made for a 
sore infected from a patient, which almost 
destroyed me by its systemic injuries. The 
wound gaped widely with thick edges, and 
the surgeon said it should be sutured. I 
said, " Let the edges alone, Nature will make 
them right;" and then I alluded to a case 
where Doctor Gilman Kimball, the veteran 
ovariotomist, sutured an abdomen that had 
been so enormously distended that large 
transverse folds of skin two inches high sur- 
mounted the vertical median line ! Yet Na- 
ture smoothed down both cases as well as if 
they had been sutured to make all the edges 
meet. 

In a fracture of a bone what more does 
the surgeon than to reduce it and retain in 
position, while the extraneous effused blood 
and the reunion of the fragments are restored 
by Nature's processes ? Of course the sur- 
geon or patient can spoil the healing; but I 
am dealing here with good work in surgery. 
In laparotomy for appendicitis the surgeon 
removes the offending body, but he depends 
entirely on Nature to do the healing when 
relieved from the offending part. If Nature 



*37 

healed not, death would surely follow. In- 
deed the history of surgery tells of many a 
case where there was a splendid operation, 
after which the patient died from shock or 
poor constitution, which terms are but syno- 
nyms for the inability on the part of Nature 
to do her accustomed work. People have 
been disemboweled, their entrails trailed in 
the dust, and yet have recovered without 
antiseptics! Persons have been impaled on 
hay-forks. A man once had a crowbar blown 
through his skull and emerge through the 
crown, and yet recovery has followed. In 
such cases the conventional remark is that his 
constitution saved him. Surgical shock means 
that the constitution receives a blow, that 
may or may not be fatal, according to the 
nature of the individual resistance and re- 
serve force. Independent of all surgery is 
Nature's power of recuperation. So, after 
all, Nature performs the cure in surgery. 

The action of medicines depends on the 
condition of the system — i.e., Nature's power. 
When I was young there used to be epidemics 
of dysentery and scarlet fever of a malignant 
type, and I have heard my father say the 
first cases were invariably the most severe 
and would not respond to drugs; even strong 
emetics would not act. This he attributed 
to the severity of the type of the disease, 
which exhausted the vitality so that it would 
not react to the influence of medicines any 
more than a dead lion to a kick. Sometimes 
this want of reaction is impossible to explain. 
I once saw in consultation a family vomiting 
from the eating of baked peas. After several 
hours' administration of medicines to arrest 



»3« 

emesis I suggested to the attending physician 
to give emetics and finish up the vomiting. 
They took the sulphate of zinc, kept it down, 
ceased to vomit, and all speedily recovered. 
I think it cannot be denied that Nature has 
the largest share in the cure of fatty ills. 

I tell my pupils sometimes, "Attend to 

Mr. A or Miss B , see that they have 

all needed care, and then forget all about 
them: let Nature do the rest." Introspective 
thoughts, making one's self a debating so- 
ciety, are very destructive of Nature's proc- 
esses, and have slain when otherwise the 
lives might have been saved. I have wit- 
nessed worry bringing back oils and fats into 
the specimens after they had been removed 
by treatment, simply because worry reduced 
the vital forces. 

Patients with fatty ills may present them- 
selves so worn out as not to respond to the 
measures employed for relief. I have had 
some patients who appeared, in common par- 
lance, "too far gone for any good," and yet 
they recovered because realizing their weak- 
ness and limited chances of recovery they 
have held on to the measures offered with no 
diversion of mind, no inside debating society, 
nor great overwhelming depression, which 
physicians cannot heal. Per contra, I once 
knew an ill wife's recovery to be upset by 
a knowledge of her husband's marital infi- 
delity; this knowledge wasted so much force 
that Nature had no power to cure; when 
Nature could not hold her own, devolution 
wrecked the case. The relation of Nature 
to the cure of these fatty ills is as Air to 
Music. No air, no music. 



139 

As remarked before, the future of medi- 
cine will be curing disease by removing 
causes, such as bad foods; giving few foods 
on which the body will thrive; oiling the 
machine with hygiene, massage, medicines; 
conferring force by the materia alimentaria 
(Joseph Jones, M.D., LL.D.), and then Nature 
does the cure ! On these principles I, from 
personal experience and the experience of 
others, am sure fatty ills are not incurable ! 
One must not, however, sit down, fold his 
hands, and gracefully wait for death, but ap- 
ply the principles I have tried to lay down, 
and try remedies as is done in recognized 
curable cases. 

Here is a fine field for state medicine. Just 
as it is commanded to leave off contention 
before it is meddled with, so fatty ills can 
best be relieved by treatment beforehand 
(prophylaxis), by teaching people to avoid 
such ills by proper feeding. — A sapling is 
easier uprooted than a tree. 

" For persistent albuminuria I agree 
" with Roberts and Rosenstein that we 
" have no remedy of the slightest value. 
" Nothing indicates more clearly ourhelp- 
" lessness in controlling kidney metabolism 
" than our inability to meet this common 
" symptom. "* 

While respecting this dictum and those 
uttering it, I should testify falsely if I 
should say that I have not personally 
known cases of persistent (chronic) albu- 
minuria, characterized by fatty epithelia, 
kidney casts, amyloid bodies, oil on blood 
slide, fat in leucocytes, to be cured by 
treatment. 

* Osier's "Practice of Medicine," 1S95, page 787. 



VII. 

SPECIAL AND PARTICULAR TREATMENT, 
WITH ILLUSTRATIVE CASES. 

I hare no quarrel with Doctors Osier, 
Roberts, and Rosenstein, but I have with 
their conclusions. I propose to offer evidence 
that in cases of persistent albuminuria, fatty 
epithelia, kidney casts, amyloid bodies, oil 
in the blood and urine, and fat in the leuco- 
cytes, such signs have disappeared, and the 
patients were permanently cured so long as 
they let causes alone. 

I will first present collateral evidence. 

Some years ago the Reverend J. C. Chick- 
ering, D.D., came to me in great distress 
about his eyes. Oculists had told him he 
had amaurosis, and that in order to postpone 
the inevitable blindness he should not preach 
any more. He asked if this could be avoided. 
The reply was that I disliked very much to 
go against the^diagnosis, but thought if he 
would eat two-thirds by bulk of animal food 
to one-third of food from the vegetable king- 
dom he could preach and save his eyes from 
being worse. This advice was followed. He 
died at the age of seventy-eight, I think, of 
peritonitis. A short time before his death I 
saw him crossing Park Square, Boston, Massa- 
chusetts, crowded with street-cars, other con 
veyances, teams, and people. He was alone, 
caring for himself like any other person, and 
perfectly calm. He recognized me at a glance, 
140 



T4I 

saying that he could see as well as he did in 
1872; that he had preached right along, 
especially to the " spirits in prison" (Con- 
cord Reformatory) on the previous Sabbath! 

In 1890 I visited my native town and over- 
took an old native on the sidewalk. As we 
proceeded together he remarked his oculist 
told him he was suffering from glaucoma and 
going to be totally blind; his vision troubled 
him very much, and he was disheartened. I 
told him that it was a case out of my 
line, but the result in the case of Doctor 
Chickering was so favorable I thought my 
plan was worth trying. In a few words I 
gave him the cue, and we parted. Two 
years later we met upon our native heath 
once more. He was much elated; said he 
followed my directions, and his eyes were 
improving all the time. I told him to hold on 
as he was doing. In June, 1896, I saw him 
again. Without speaking I made signs to 
test his sight, which proved to be good, and 
that too without glasses ! He informed me 
his vision was about as good as it ever was, 
and that he was giving up the use of glasses 
entirely. His age was then seventy-two. 

Some twenty years ago a mother lay sick 
under a complication of diseases, in which 
angina pectoris was a prominent feature. 
The attacks were almost daily, having the 
typical character so graphically described by 
Sir B. W. Richardson, of London.* She was 



*The patient read this account lately and said it 
was a correct description of her case, saving the 
clause that asserted that all such cases died. As 
Sir Benjamin had entertained this lady at his 
house in London in 1889, I wrote him about it, re- 



142 

prostrate in bed, could not eat, and too weak 
to raise voice, hands, or head. The heart's 
area on percussion was larger than normal; 
the first sound presented a sonorous murmur 
heard towards the left; aortic sounds normal; 
impulse increased. The sense of constric- 
tion, suffocation and impending death was 
markedly characteristic, as if a giant gripped 
her chest. She was not expected to recover. 
Still, by carrying out the plans here laid 
down she made a good recovery, and now 
lives to bless her home with the sunshine of 
her presence! 

Nearly two years ago a girl fourteen years 
old came under my care; she was larger than 
the average woman. She suffered mild at- 
tacks of catalepsy, that had persisted for 
more than a year, occurring frequently. She 



ferring to Doctor S. Weir Mitchell and his already 
alluded to experiments in producing fatty degen- 
eration of the eyes in guinea-pigs and frogs by the 
subcutaneous injection of sugar dissolved in water. 
Since Sir Benjamin has recently died of a masque- 
rade of fatty degeneration of the brain (apoplexy), 
his reply is here appended: 

44 Dear Doctor Cutter— Your letter gave me 
great satisfaction, and I am much pleased to know 
that your patient no longer suffers from her old 
enemy. You seem to have an excellent memory 
to keep in mind so long my 'Synthesis of Cata- 
ract.' 

"When you come to London again we shall be 
delighted to see you, and, with our kindest remem- 
brances to your wife and yourself, 

Believe me to be, yours faithfully, 

B. W. Richardson. " 

—Post-mark date, August 17th, 1896. He died 
November 21st, 1896. 



Hi 

presented free oil in blood; fat in leucocytes; 
albumen in urine, casts, fatty epithelia very 
marked; anteversion and flexion of the womb, 
and uterine and vaginal hyperesthesia. Had 
been overworked at school. Catalepsy worse 
during menses. This case was treated on 
the plans for fatty degeneration; for the alle- 
viation of the local troubles, with iodoform 
suppositories and vectores until the hyper- 
esthesia was relieved; then the flexion was 
straightened out and the lesion remedied 
by the judicious use of the uterine sound. 
In three months the catalepsy permanently 
disappeared, and along with it all signs of 
fatty transformation, save fatty epithelia, 
and these became very few in number, and 
there were very few fat globules. Surely 
it seems that there was some connection 
between the catalepsy and the fatty metab- 
olism. The case is the more striking be- 
cause there was a restoration of the bust 
of the chest, from its caved-in flatness and 
narrowed antero - posterior diameter of the 
thorax. There was no conventional bro- 
mide treatment, etc., by me. She had had 
enough of this and of conventional diet be- 
fore. At last accounts (1897) she remained 
cured, save for a few oil globules in the 
blood. 

I think that, as food causes were traceable 
in almost every case of epilepsy I have seen, 
it is reasonable to expect the cure of this 
malady to come through proper feeding. 
Epileptic disturbances of the sensory and 
motor nerve centers are met with in Bright's 
disease of the kidneys, — one of the worst 
cases of convulsions I ever saw was in a man 



144 

suffering from this nephritic lesion. Cer- 
tainly this clue to the treatment of such 
lesions unamenable to drug medication is 
worthy of much thought by the clinician. I 
present a few cases: 

Case i. — This was a petit mat, but big 
enough to wreck the brilliant prospects of a 
young graduate collegian. His urine showed 
albumen, fatty epithelia, and kidney casts — 
not all at once, but at separate intervals. At 
times the abundance of the kidney casts ex- 
ceeded any I had ever met. This case was 
much relieved, but the patient finally aban- 
doned treatment on the advice of a physician 
who interfered because of tapeworm, and did 
not believe as I did. The case remains un- 
cured. 

Case 2. — Girl 13 years old, epileptic, with 
le grand mal. Albumen in urine very marked; 
casts and fatty epithelia. She was treated 
according to the plan heretofore laid down, 
but my instructions were carried out only 
with great difficulty because of absence of 
mental control of appetite, a defect that dis- 
couraged her friends (she was an orphan), 
and her case would have been given up but 
for the persistence of the physician. For 
example, in spite of all warnings, she drank 
molasses from the jug, as if it were water, 
thus upsetting her treatment. With every 
upset the albumen, casts and fatty epithelia 
would reappear. Finally a promise of a nice 
white dress prevailed, and she tided over 
into such good health as availed to maintain 
proper psychic control. The albumen dis- 
appeared last; the casts and fatty epithelia 
went first. I saw her people some years 
after her treatment, and they reported her in 
splendid health. All concerned were much 
gratified with the outcome, and well they 



145 

might be. At this writing (1897) she con- 
tinues well. 

Case j, — Middle-aged man; le grand tnal; 
presented all the stigmata of fatty degenera- 
tion, though not to excess; a bad case with 
no self-control. He would deliberately eat 
forbidden food and revive his epileptic seiz- 
ures, and at such times he would emphatically 
deny having eaten anything amiss, though 
the morphologies of the blood, urine and 
sputum furnished ample evidence of his 
dereliction, aside from the macroscopic evi- 
dence furnished by his seizures. A peculiar- 
ity in this case was the existence of an 
abundant mycelial vegetation in his mouth 
that lined it white, and exhaled a perfume 
not celestial, and bad enough to knock you 
down if you came within reach. This case 
was a failure, because the right morals could 
not be inspired. 

I herewith also present histories of other 
cases of fatty degeneration: 

Case /. — Four years ago an eminent sur- 
geon was ill with chronic and acute bron- 
chitis, asthmatic variety, and with albumen, 
fatty epithelia and casts in the urine. His 
sputum had for a long time been loaded with 
granular massive and crystalline gravels; also 
with blue, bronze and emerald-green pig- 
ments. His blood showed free oil, fat in 
white corpuscles, and emerald -green pig- 
ments; he was ill in bed for several months, 
and was treated partially on the plans here 
laid down, — I say partially, as, being a great 
favorite in the profession, he had plenty of 
iraternal medical advice and attention shown 
him, and could not but yield to their kind- 
nesses. Still he made a good recovery, and 
is to-day practising in his office comparatively 
well at his advanced age of seventy-six ! Says 



146 

his urine is normal. It should be added, as 
further showing the character of his disease, 
that after his sickness he developed cataract, 
which has been successfully removed by sur- 
gery. 

Case 2. — Some ten years ago an eminent 
clergyman, 64 years old, overworked as treas- 
urer of a large missionary society, was ex- 
amined because of what he believed to be 
"rheumatic and neuralgic pains" in back and 
limbs. In his blood were found: Free oil, 
and fat in white corpuscles; emerald-green 
and bronze pigments; red corpuscles some- 
what adhesive; rarely massive fibrin filaments. 
The urine, studied two or three times a week 
for several years, showed albumen, casts, 
fatty epithelia, protoplasmic and filamentous 
catarrh, and amyloid. These abnormalities 
were not always present together nor in large 
quantities, still they were positive and suffi- 
cient to class the case under this head. Diag- 
nosis of rheumatism not sustained; the pains 
were neurasthenic, locomotor ataxic, and from 
partial paralysis. — They were Nature's warn- 
ing to "look out for the engine when the 
bell rings," and this engine I now think was 
locomotor ataxia; in other words, he was in 
the pre-stages of locomotor ataxia. The 
dominie used to do two men's duties, kept at 
work during this illness, and did not lose a 
day, while others in his office calling them- 
selves well were off on vacations, or on ac- 
count of poor health. Finally his left shin 
was injured by striking against an open 
drawer of his office desk, and though it was 
apparently a slight affair it caused more 
trouble than it ought, as injuries which in 
health would not be noticed become grave in 
cases of fatty ills. — For example, the late Doc- 
tor Elsberg had his instep pinched by a tight 
boot, and it became the immediate cause of 
his death. This was because of the systemic 



»47 

weakness caused by the fatty metabolism. 
However, this case made a good recovery 
from his barked shin, though much against 
his will he had to go to bed on account of it. 
He was under treatment for some years, but 
was termed a " juicy old man " because of his 
splendid business abilities, literary attain- 
ments, and true, harmless, spontaneously bub- 
bling mother wit. We could never get him 
closely down to business medically, right 
along, and when he did yield obedience the 
abnormal morphologies would disappear, and 
he would feel nicely. At the last examina- 
tion his urine was slightly albuminous. Under 
the circumstances the success attained was 
splendid. 

Case j. — A young man 18 years old, with all 
the stigmata of fatty ills, was brought to me 
by his father; the mother was ignored, but 
I asked that she come and see me, as I felt 
she, of all connected with the case, should 
consent to it and understand the plans, be- 
cause her business was to see to the food of 
the family. The father said, "I will see she 
carries out all your directions." Nevertheless 
the mother gave her son things to eat as she 
thought best; upset her husband, doctor, and 
son. Mothers who have for many years 
selected and prepared food for families come 
to feel that they know all about dietetics; 
and I still think if I could have seen this lady 
and explained matters the boy could have 
been saved. 

Case 4. — About ten years ago a middle- 
aged widow consulted me, suffering from a 
complication of diseases, with a systemic 
condition of fatty and fibrous degeneration; 
had been sick a long while, and I was her 
last medical hope. There was oil in blood, 
fat in leucocytes, albumen, fatty epithelia 
and amyloid in urine; a sessile fibroid large 



148 

as the fist at the fundus of the uterus, and 
anteversion; gravels in sputum; asthma; pleu- 
ritis, etc. She was put on the plans here 
outlined. In two months the first four symp- 
toms disappeared. Though now a valetudi- 
narian, she lived in comparative good health 
and activity. This case shows the wonders 
of food as a medical power. 

Case j. — About nine years ago the son of the 
above widow came under treatment for ner- 
vous prostration. Unable to study, he was 
fearful of giving up his class on this account. 
I found in his urine protoplasmic, filamentous 
and Indian club catarrh, albumen, cylinders, 
and fatty epithelia. The blood was not much 
out of normal condition. By following the 
usual line of treatment he was cured, and the 
abnormal stigmata removed; he is now (in 
1897) hard at work as a civil engineer and 
poultry farmer. 

Case 6. — About two years since a clergy- 
man came under my charge for diabetes, as 
diagnosed by five other physicians. There 
was confirmation of diabetes mellitus with 
detection of albumen, cylinders, and fatty 
epithelia in urine. In a few months the al- 
bumen, cylinders and fatty epithelia disap- 
peared; in a year the sugar also disappeared, 
and has since remained absent. The gentle- 
man's health is fine, and he is hard at work 
at his professional duties in the Episcopal 
Church, In 1896 he spent a summer vaca- 
tion in Europe. 

Case 7. — Some six years ago a middle-aged, 
tall, lean, pale and wan business man, a great 
sufferer from insomnia, neurasthenia and 
prostration, applied to my son for aid. He 
was found with protoplasmic, filamentous 
and Indian club catarrh, albumen and casts 
in the urine. He cooperated faithfully with 
the treatment, and is now able to sleep; his 



149 

abnormal morphologies have also disap- 
peared, and at last accounts he was a well 
man. This instance is the more remarkable 
because this combination is a very hard one 
to cure. The lack of vital dynamis interferes 
with the carrying out of treatment which 
takes time and trouble.* 

Case <P. — Three years ago a lady who had 
chronic diarrhoea, or consumption of the 
bowels, for the space of twenty years, came 
for treatment. She presented the following 
evidences of fatty degeneration: Free oil 
in faeces; ditto in blood, fat in white blood- 
corpuscles; emerald-green pigments in blood; 
albumen, casts and fatty epithelia in urine. 
On the general principle of removing fer- 
menting food, the consumption of the bowels 
was cured by Nature. The signs of fatty 
degeneration held on longer, but she is now 
in the enjoyment of perfect health. This 
record came from her fidelity, maintained 
under strong resistance from the outside. In 
the day of judgment the Lord will reward 
according to fidelity, not according to imme- 
diate outward results; but does not the case 
show the same principle of Nature in dealing 
with the biology of the human body ? 

Case p. — Twelve years ago a man was 
found with protoplasmic and filamentous 
catarrh, albumen, fatty epithelia, and cylin- 
ders in urine. He was under great stress of 
mind and body, but under treatment im- 
proved and passed out of observation until 
about two years ago, when he was reported 
as having had an apoplectic attack, partially 
paralyzing one side of his body, — he was 
over seventy years of age. From the apo- 
plectic shock he made a good recovery. 



* Unless specified to the contrary all the cases 
here are mine. 



Most of the time he has been careful of his 
diet on the lines here laid down, but not being 
under medical inspection he probably wavered 
from it somewhat. The hemiplegia seems to 
prove that the degeneration had affected the 
muscular coats of the cerebral arteries; but 
his fine condition at the age of seventy-four, 
when fatty ills are normal, to use a Hiber- 
nicism, is certainly good evidence of the 
truth of the doctrines here laid down. Medi- 
cally speaking, there is more devolution than 
evolution; that is, patients left to themselves 
naturally tend to a lower standard for them- 
selves when they have no expert to coach 
them medically. The principle shown in this 
case is that by stopping causes, sustaining 
Nature, and oiling the machine therapeutic- 
ally fatty degenerations will disappear if 
given half a chance so to do. 

Case 10. — Professor Louis Elsberg, M.D., 
about ten years ago undertook the line of 
treatment here laid down for albumen, casts, 
and fatty epithelia in the urine, and for oil 
in blood and fat in white blood-corpuscles; 
his appearance was waxy and lardaceous. In 
a few months these abnormal signs were 
gone, and he was pronounced well. Then 
he said, " I am now going to eat anything I 
like !" These words cut me to the heart, for 
he was my beloved friend. I knew he had 
uttered his death warrant. No words of 
mine availed to change his purpose, and he 
decided to live to eat, not eat to live. Of 
course I could take no more responsibility 
after this ! The next I knew of him he had 
a very bad sore foot, the trouble being caused 
by wearing a pair of new tight boots. I ex- 
amined the lesion, but it was so trifling it did 
not appear to sustain his assertions and as- 
servations of its great painfulness. But he 
was right. He was again in the toils of sys- 
temic fatty degeneration, and unable to resist 



J 5* 

a small injury like this ! The foot never got 
well. Unwisely he worked hard, doing, in 
addition to his own duties, the labor of a 
professor of a post-graduate clinic, who dis- 
appeared at that time and never returned; 
exposed himself to inclement weather, and 
fell ill with bronchitis and pneumonitis. All 
the earnest, faithful, multifarious efforts, lov- 
ingly and persistently rendered by many 
physicians, availed nothing, simply because 
his fattily degenerated tissues had not force 
enough to resist disease and react to stimu- 
lants and tonics. He died much lamented, 
as he was a very eminent physician, a whole- 
souled man, and of rare philosophical charac- 
ter. Oh, if he could have adhered to his 
diet he would have continued to bless my life 
with his soulful richness ! Eheufugaces! 

Case ii. — A millionaire of 72 years was 
treated on these plans for albumen, fatty 
epithelia and casts in his urine; for oil in the 
blood and in the leucocytes; for apoplexy of 
the skin, — i.e., rupture of the small dermal 
arteries so that he was marked all over his 
body with stellated blood-spots ecchymosed 
under the integument. He had arcus senilis 
and difficult vision; also alcoholism. By 
close and careful attention the stigmata of 
fatty degeneration were removed so that 
he was called well; but it seems that he re- 
sorted to domiciliary tippling to a large 
extent, which upset all care and treatment, 
as naturally might be expected. He did not 
live long after I was dispensed with, though 
he had plenty of attentive physicians, who 
understood not his case. They believed not at 
all in the idea that fattily degenerated tissues 
can be restored if the causes are stopped, the 
machine oiled, and Nature thoroughly sus- 
tained. This is history, not mere complaint, 
for the professional gentlemen acted up to 
their knowledge and convictions. Under the 



152 

alcoholic environment, which was kept secret 
for a long time, it is a wonder that the man 
fared as well as he did. I think this case 
shows something of the relations of alcohol- 
ism to fatty ills. 

Case 12. — The wife of the patient in Case 
ii, a nice, corpulent old lady, presented the 
macroscopic and microscopic signs of fatty 
degeneration without alcoholism or dermal 
apoplexy; but she had very troublesome 
epistaxis, which the rotten condition of her 
blood-vessels made it difficult to arrest in 
the spongy tissues of the nose. She was a 
kind, good old soul, and did the best she 
could. Much distressed about her husband's 
alcoholism and illness, she could not check it. 
Still she improved somewhat in health on the 
plans here laid down, but the loss of vital 
force from worry strain and disappointment 
served to block her course. She lived but a 
short time after her husband dismissed me. 

Case 13. — Mrs. E. D , 45 years of age, 

asthmatic for twenty -six years previously, 
had anteversion of the uterus, and presented 
fatty epithelia, casts and albumen in urine. 
She was treated specially for her asthma, 
which in two years was permanently cured; 
along with it went the fatty epithelia, casts, 
and albumen. She was restored to fair health, 
when she felt that her wardrobe should be 
completed by a full-length sealskin cloak. 
While traveling for this purpose she took 
cold from exposure and weariness. She had 
a peculiar sickness, in which cerebral symp- 
toms predominated. Delirious and fatuous, 
she died. 

Case 14. — Judge , 63 years old, had 

been attended by eminent medical talent, 
that made an agnostic diagnosis, so far as 
the patient was concerned. There was albu- 
men with fatty epithelia and casts in the 



iS3 

urine; in the blood oil, and fat in the leuco- 
cytes. Heart's impulse and area of dulness 
on percussion increased; sounds muffled and 
distant; no valvular lesion. The patient was 
large and fleshy, weighing over two hundred 
pounds. When the diagnosis was made and 
reported to him, it was met with the state- 
ment that his physician had told him there 
was no cardiac disease nor anything the mat- 
ter with the urine, especially no albumen; 
but tests made in his presence proved the 
contrary. When the urine was referred back 
to the collegiate expert the presence of albu- 
men was admitted, and not before. He im- 
proved under treatment, but all the while 
was consulting and hobnobbing with the 
physicians who had made the aforesaid diag- 
nosis without any hope of a cure. The effect 
of this cross-purpose work was bad: he gave 
up the treatment here laid down, and died as 
his physicians said he would die; thus proving 
the correctness of their prognosis and the 
futility of efforts to cure, when one physician 
is pulling one way and the others another ! 
Such doings spoil chances. These things are 
said, as before, by way of history, and not of 
censure; the history of all advances in knowl- 
edge is filled with like instances. Only it 
seems like a dog-in-the-manger business, 
where there is a most valuable human life to 
be saved. 

Case jj. — Four or five years ago a very 
anxious and nervous wife of middle age came 
to me for an induration in her right breast. 
It had been pronounced cancer by a good 
surgeon, who recommended amputation. It 
appeared to be a fibroma. Treated on the 
plans of nutrition here laid down, it departed 
in a few months. During this time, when she 
had her nerves quieted by the good progress 
of what she called her il cancer case," she 
turned her attention to her husband, who was 



iS4 

apparently quite well and attending to a 
large business. She insisted on his being 
examined, and her fears were realized by the 
discovery of free oil in the blood, fat in white 
corpuscles with albumen, casts; fatty epi- 
thelia, with protoplasmic and filamentous 
catarrh, in the urine. He was readily cured, 
and remained so at last accounts. 

Case 16. — Twelve years ago a multi-million- 
aire was treated for fatty degeneration of the 
kidneys, as evidenced by albumen, casts, and 
fatty epithelia in the urine; was troubled more 
by hebetude than anything else. He once said 
to his physician he thought he would hire a 
man to go behind him with a horsewhip, with 
orders to flog when he flagged. — This must 
have been on the principle of conferring force 
by impacts! I told him his tissues were turn- 
ing into fat and the whip would only waste 
them more. In a few months all the insignia 
of fatty metabolism had disappeared, when he 
declared from motives of economy (!) he 
would run his case himself alone. He did so, 
and in a few months literally ran it and him- 
self under the ground! It is not enough to 
obtain the evidence of health in the body 
systemic, but this condition must be main- 
tained until the tissues are strong enough not 
to devolute. Generally speaking, a fatty-ill 
case should be under medical attendance for 
six months or longer. — Destroying is easier 
than building up. This gentleman was over 
70 years of age, an extremely hard worker, 
and unused to consider himself as entitled to 
any special consideration of rest as to mental 
and physical labor. 

Case 77. — A single lady, like the wife of 
Case 15, with tumors of the breast, which a 
" cancer doctor " pronounced malignant and 
only removable by caustic paste, was put on 
treatment, and her condition made a special 



i55 

study for a long time, — the usual signs of 
fatty degeneration were found in the blood 
and urine, though not marked. As time went 
on the stigmata disappeared along with the 
tumors, and she is now quite well. 

Case 18. — Sister of Case 17, with like stig- 
mata, but with more signs of alienation, oc- 
casionally presented fat in blood, albumen, 
fatty epithelia, and casts in urine, which evi- 
denced she was skirmishing with a masquerade 
of fatty degeneration. At the present time 
she is much better and well-nigh free from 
the ominous signs. During treatment it was 
sometimes difficult to keep her strictly to the 
diet, but the closer she kept the more the 
insignia were absent. 

Case ig.—ln 1876 one of the most eminent 
pedagogues in the world was in the pre-stage 
of tuberculosis of the lungs. He was cured, 
and in 1879 went to Japan, seriously charged, 
in case he was ill, what diet to follow, no 
matter what physician he had. In 1881 I 
received a letter from an American physician 

residing in Tokio, stating that Professor 

had Bright's disease of the kidneys (diagnosis 
confirmed by the German professor who was 
at the head of the medical department of the 
University of Tokio); that they could not 
get him to eat anything but what I had told 
him to eat; that however good the diet might 
be for America it would kill him in Japan; 
and that they wished I would order him tc 
feed as they desired. I wrote to them that 
if they changed his diet he would die, and 
that I wished them to let him alone as to 
food. They did so. He lived to June, 1893 
in the enjoyment of good health, save when 
he would eat too much carbohydrate food. 
For example, in 1893 he taught in a school in 
Michigan, where he worked very hard, ate 
all the " goodies" they gave him, though he 



156 

knew better. His kidney degeneration re- 
turned in full force, with all the stigmata, 
but a few months of going back to prescribed 
diet restored him again. But death finally 
overtook him in a way of psychological 
depression, which it is refreshing to con- 
template in these days when so many think 
that "marriage is a failure !" The beloved 
wife of his youth died seventy days before 
him, and he took her death literally "to 
heart; " besides, he exposed himself to the 
inclemencies of the weather, took cold, and 
his disease settled on his heart, which mani- 
fested the signs of inflammation and pericar- 
dial effusion. He meantime attended to his 
professional duties, planning for future work 
as if a young man! As expected, the heart 
suddenly ceased to beat. At the time of his 
death his head was covered with iron-gray 
hair; he could see without glasses; his hand 
was steady; mind clear; and he had just com- 
pleted a plan for a new system of pedagogy 
in music ! 

Cases 20 and 21.— During the absence of 
Case 19 in Japan, his wife and daughter were 
both ill, and examination revealed albumen, 
casts, and fatty epithelia in the urine. Both 
were cured.* 

Case 22. — About eighteen months ago a 
girl of 20 came under care for consumption; 
besides the evidence of this disease she pre- 



*I did not see Mrs. at the time of her death, 

and therefore cannot speak from personal observa- 
tion. I was informed by Professor that her 

physician got her daughter to boil her urine in a 
teaspoon and report to him whether it was changed 
or not ! Comment is needless; but I would ask, 
was this procedure worthy of the professional 
honor and dignity of this shirking attendant? Was 
it not shystering? I hope none of my readers will 
ever be guilty of such remissness and shiftlessness. 



i57 

sented fatty epithelia, casts, and albumen in 
urine, oil in blood, and fat in leucocytes; 
vaginal and uterine hyperesthesia; high sys- 
temic fever during the after part of the day, 
though there were detected but very few lung 
fibers in the sputum. On adopting the usual 
treatment the urinary stigmata disappeared, 
but not the oil and fat from the blood mor- 
phology. The lungs healed; the lung fiber dis- 
appeared from sputum. The fever kept up, 
and because of this the treatment was aban- 
doned ! Still it was good to have checked 
the fat metabolism under such difficult envi- 
ronments. I am now inclined to think that 
the degeneration was a prime element in the 
production of the diurnal fever, which fever 
I regard as a result of Nature's efforts to rid 
the body of intruders. 

Case 2 j.— Some thirteen months since a 
lady of 60 came under my care for rheumatism 
and anchylosis of the right shoulder -joint; 
for want of power in the knee-joints; for 
inability to raise herself in bed and to go up 
stairs alone. Locomotor ataxia was thought 
of, and perhaps it was present; indeed, I now 
think she was in the pre-locomotor ataxic 
state; but the presence in the blood of oil, 
fat in leucocytes, amyloid, emerald green, 
bronze, and other colored pigments; in the 
urine of amyloid bodies, fatty epithelia, casts, 
albumen; in the faeces of free oil, — all pointed 
to a systemic condition of fatty degeneration. 
One year's treatment sufficed to remove all 
the stigmata except very slight albumen and 
occasional fatty epithelia. The anchylosis 
and pains disappeared, and locomotion was 
restored. It should be said that she was an 
admirable patient, obedient, faithful, calm, 
and single-minded; she saved all her forces 
to use for recovery; also she was blessed 
with a beautiful, ruddy, grown-up daughter, 
who faithfully ministered to her wants and 



*58 

imparted dynamic force to her physically and 
psychologically, with great advantage. 

Case 24. — I was suddenly summoned to a 
man 65 years old under treatment for chronic 
Bright's disease of the kidneys, as evidenced 
by the urinary and blood morphologies, and 
found him in convulsions which were exactly 
such as are seen in puerperal cases; he could 
swallow nothing and was unconscious, so 
chloroform was applied to the nape of the 
neck as follows: A small pledget of cotton 
was moistened therewith, placed on the nape 
and held there by placing against it the bot- 
tom of a glass goblet; the heat of the body 
evaporated the chloroform, and in a few 
minutes erythema and almost blistering fol- 
lowed, — the action was quick, sharp, and 
painful. Signs of consciousness appeared, 
and soon he was able to converse. The con- 
vulsions did not reappear. Afterwards there 
was some improvement as to the stigmata of 
his degeneration; but later they devoluted 
and he died. It should be said that this man 
suffered a great loss of force from the recent 
death of his wife and terrible sickness of a 
favorite daughter; this withdrawal deprived 
Nature of much -needed dynamis. Nature 
cannot run a steam-engine unless water is 
conveyed into vapor. 

Case 25. — A man 65 years old, presented 
in 1890 all the evidences of Bright's disease 
of the kidneys: The albumen was copious; 
upper eyelids swollen; mind appeared to 
be affected, as he would not listen to the 
reasonable entreaties of his noble wife, but 
insisted that there was nothing the mat- 
ter with him save weakness; had no pain; 
said he felt well enough. He would not fol- 
low directions. He was reaching out for 
other aid and dispensed with me, saying that 
he would be best cured by massage without 



159 

diet and medicine. I was informed that he 
died two months later.* 

Case 26. — A girl of 13 had scarlet fever 
and her first menses appeared at the same 
time, — in fact the rash came out and the 
menses appeared the same day. Albumen, 
casts, and fatty epithelia were present in the 
urine. She was put on treatment and got 
well through with the various phases of the 
scarlatina, but the urinary morphology per- 
sisted for six months before it disappeared. 
This was twelve or fourteen years ago, and 
the girl subsequently developed into a beau- 
tiful and healthy woman.f 



*Pain would have been a good thing for this 
case. He would have appreciated his situation 
better. I am not at all sure but that the conven- 
tional idea of the medical profession is somewhat 
responsible for such misapprehensions. That is, 
the idea of relief from pain is held so prominently 
forth that some come to believe in the delusion 
"no pain, no disease !" Often opium is given for 
relief, and when the pain is relieved the work is 
said to be done. But pain is not the disease; it is 
rather a result of disease. The same is true of 
fever. Remove the causes and both pain and fever 
will disappear. Let me not be misunderstood. 
There are cases when agony must be relieved by 
narcotics and anodynes; but this must be done 
after some consideration and not perfunctorily in 
a routine way. It should also be said that the re- 
moval of pain stops the leaks of dynamis so that 
sometimes Nature has force enough saved to cure. 
But we are treating of chronic and not acute dis- 
eases and insist on the removal of causes as a 
prime necessity. 

fThis combination is a rare one. She was sister 
of the patient noted under puerperal convulsions. 
She had lived largely on carbohydrates, which was 
the cause of her illness, which at one time was so 
serious as to excite the most grave apprehension. 



i6o 

Case 27. — A retired locomotive engineer, 
60 years old, in January, 1896, was confined 
to his bed with an enlarged and valvularly 
diseased heart, dropsy of limbs, albuminuria, 
and given up as incurable. In this state he 
was seen by a relative who had been in a 
like condition and successfully treated by my 
son, Doctor John A. Cutter. Layman -like, 
he prescribed hot water, beef, and dandelion 
root extract. In one week the man was at 
his work! Later he was under my care, and 
I found albumen, casts, fatty epithelia in the 
urine, and oil in the blood, with fat in the 
leucocytes. He improved, but, exposing him- 
self to cold and wet on a steamboat excur- 
sion, contracted acute bronchitis of a severe 
type. His brother, a physician, naturally 
was called in to see him, and his prognosis 
was fatal; he said it was of no use for him to 
try to get well; advised him to go into the 
country and live as long as he could. He 
went. The uncle says that he received a 
letter from him dated November 12th, 1896, 
in which he writes: "I have been sitting in a 
chair since the 5th of June, unable to help 
myself; cannot lie down; ... my body 
is nothing but skin and bones, which up to 
the first of September was filled with water 
as big as a barrel. My legs are like a piece 
of raw beef with, I think, a thousand holes 
in them, which I cannot compare with any- 
thing but a nose on a sprinkling pot, discharg- 
ing from two to three gallons of water every 
day. . . . The smell of the discharge is 
terrible, but I think I am gaining a little, for 
I can stand on my feet with a little help. 
. . . I have had several doctors, but they 
could not do anything for me." He later 
died. 

It is a pity that this patient could not have 
adhered to the treatment laid down, espe- 
cially as he exhibited such a wonderful vi- 



i6i 

tality. It is not the writer's fault, as treat- 
ment was offered gratuitously. He threw 
away all his chances. 

Case 28. — Mrs. , aged 45, in 1892 was 

taken so ill she was disabled from work. Her 
sickness was attributed to defective house 
plumbing, that allowed sewer-gas to escape 
and permeate her apartments, and she re- 
moved at once. Her urine presented albu- 
men, casts, fatty epithelia, which latter were 
very abundant and characteristic; indeed 
they appeared like vaginal epithelia when 
vaselin has been used to facilitate a digital 
examination. There was loss of appetite, 
fever, prostration, and weakness. The fatty 
epithelia held on longer than the casts or 
albumen. But by following persistently the 
means here recommended she recovered in a 
few months and has been well ever since. She 
has developed a great decision of character, 
manifesting strength, energy and promptness 
of action in an emergency that most wives 
succumb to without any resistance. Fatty 
tissues do not confer force, they are at once 
the cause and substance of weakness of mus- 
cular and nervous tissues. 

Case 29. — Some four or five years ago a 
middle-aged wife came under my care. She 
had an enlarged heart with muffled normal 
sounds, combined with dyspnoea on going up 
ascents, and sometimes with severe attacks 
of palpitation; cerebration somewhat dazed; 
was bothered about remembering things, and 
about calling things by their right names, 
although she managed to maintain well her 
position as mother of a family and house- 
keeper; there was some uterine disturbance. 
She was found with the signs of fatty degen- 
eration in the urine and blood. Treated on 
the principles here laid down she made a 
good recovery, which has continued up to 



162 

this writing (1897). As she got better it was 
interesting to note the improvement in her 
cerebration, her movements, her facility of 
speech, and her appreciation of the change. 
She once stated she knew if she did not get 
better she would have become insane; but 
she did not realize the truth of this so much 
at the time as she did afterwards. Hind 
thought is surer than forethought. 

Case 30. — In 1882 Mr. S , a salesman 

in one of the largest Boston shoe houses, ap- 
plied to an insurance company for a policy 
on his own life. The medical examiner said 
he had Bright's disease of the kidneys, and 
advised him to do no more about it. The 
father-in-law of this gentleman, a medical 
man, satisfied himself of the truth of the 
diagnosis, and treated him without success; 
other physicians made the same diagnosis 
and treated him. The same year the gentle- 
man was brought to me, and physical ex- 
ploration revealed albumen, fatty epithelia, 
casts, and sometimes amyloid in urine; oil 
in blood and fat in leucocytes. These signs 
were marked and pronounced. He was put 
on strict treatment, which was followed for 
two years, when he was discharged cured. 
In 1895 he applied to the same company for 
a policy of life insurance, and it was granted. 

During all his treatment Mr. S kept at 

his business and is at it now (1897). 

Case 31. — Two years ago a clergyman 35 
years old applied for aid. His appearance 
evidenced locomotor ataxia, and his urine 
displayed albumen, casts, fatty epithelia; 
blood manifested oil; fat in leucocytes; red 
blood-corpuscles sticky, adhesive, and rotten. 
After returning to his home in the distant 
South he assumed the treatment, and the 
care of two churches ! It was only with 
much difficulty he could carry out the direc- 
tions given because of impossibility to get 



163 

good beef; still he persevered, and the casts 
and fatty epithelia were removed from the 
urine, though traces of albumen remained; 
locomotion did not much improve. He after- 
wards went to an osteopathic hospital, where 
he kept up the diet, and reported himself 
much benefited by the manipulations called 
by this bony name. A month ago he came 
to New York to study lip reading, but here 
he failed to keep to his diet. Locomo- 
tion was much worse than when he was here 
first. If this man could be induced to do 
less with his weak and enfeebled body his 
chances would be much improved. 

Case 32.— Captain , 60 years old, vet- 
eran of the war of 1861, alcoholist; legs and 
belly swelled; in 1894 he showed oil in blood, 
fat in leucocytes, albumen, casts, and fatty 
epithelia in urine; red and white corpuscles 
in copious clots, filamentous protoplasmic 
catarrh, uric acid, and calculi occasionally; 
complained a good deal of rheumatic pains, 
which were probably neurasthenic from the 
urinary catarrh, since his blood did not have 
the morphology of rheumatic blood. At one 
time he was treated by a "wonderful" spring 
water, containing 232 grains of saline matters 
to the gallon, and in the advertisements of 

this water Captain was gazetted as a 

wonderful cure, because he kept voiding many 
calculi! Note. — Those who drink nearly 
half an ounce of mineral saline matters to the 
gallon, especially when their systems are 
loaded with salts beforehand, must expect to 
void calculi in their urine. My son took away 
alcohol and put him on treatment along with 
the use of distilled waters. After a time he 
voided no calculi, and the evidences of fatty 
degeneration disappeared; he still keeps well 
except when he indulges in alcohol. This 
shows the tendency of this carbohydrate to 
produce fatty degeneration at least in this 



104 

case. Captain enjoys his new lease of 

life, and says he is in feelings as young as 
ever. 

Case 33. — October 3d, 1896, I saw Miss 

D , dressmaker, a fine, tall lady 35 years 

old. She was not seen then for the first 
time. In February, 1896, she had cavernous 
respiration, dulness on percussion, coarse 
sibilant rales over the right upper third front 
of chest. Her blood presented marked fibrin 
filaments; red corpuscles sticky, adhesive, 
massed; vinegar yeast, oil; fat in leucocytes. 
In sputuifl were granular massive crystalline 
and encysted gravel, with inelastic lung 
fibers. Cough incessant and harassing; loss 
of flesh and strength. On these data a diag- 
nosis was made of tuberculous cavity of 
the right lung with systemic fatty degenera- 
tion. Under treatment her cough had en- 
tirely disappeared before October 3d; no lung 
fibers, but some granular gravel yet to be 
detected in sputum; blood normal save for 
some oil, and a few leucocytes containing fat. 
Respiration normal; some dulness on percus- 
sion, over right upper third front; no rales, 
and no cavernous respiration. This was a 
truly faithful patient, and it was the third 
time her lungs had broken down and healed. 
Certainly she is an example of the wonders 
of dietetics. 

Case 34. — A man 57 years old was found 
with albumen, casts, and fatty epithelia in 
the urine, fat in leucocytes, and oil in blood. 
He went partially on the diet in 1889. When 
he came to me he had the morphology of 
catarrhal urine with occasional traces of al- 
bumen, false and true casts, and fatty epi- 
thelia. If he could be induced to live strictly 
according to rule he would, I think, other 
things being equal, recover. 

Case 35. — A young married man three years 



1*5 

ago came under my charge for diabetes mel- 
litus and Bright's disease. Besides sugar his 
urine revealed albumen, casts, and fatty epi- 
thelia, and his blood oil and fatty leucocytes; 
also complete dulness on percussion, from 
the lower edge of the right thorax to the 
level of the nipple, in front and behind to 
the angle of the scapula. The continuity of 
the hepatic dulness, the absence of respira- 
tory vesicular murmurs, the want of inter- 
costal normal fulness, the absence of complete 
flatness on percussion, rendered the conclu- 
sion inevitable that the liver was enormously 
hypertrophied. By special care the evidences 
of fatty ills soon disappeared; the sugar dimin- 
ished to one-fifth of its bulk and hung there 
for three months; finally, after remaining at 
one-sixteenth bulk, the sugar entirely disap- 
peared for a short time, and the hepatic dul- 
ness then became normal; the respiratory 
murmurs were heard where there had been 
hepatic dulness. 

I am sorry to add that this case could not 
be induced to adhere to the diet; on his own 
responsibility went to Colorado to spend the 
winter, took cold there, and died suddenly. 

To me the history of the foregoing case is 
wonderful and well-nigh miraculous. That a 
double gland of such a complicated dense 
fibrous structure, so enormously enlarged, 
should be reduced at all, justifies me in 
placing this case among the wonders of food 
effects. It is possible that none of us suffi- 
ciently realize what wonderful things can be 
done with the diseased human body by the 
simple agencies which Nature employs to 
cure when one is governed by the dictates 
of common sense and sound judgment. I 
should not have believed this history had I 
not critically studied the case. 



i66 

Case 36. — In January, 1896, Mrs. S 

bore a babe, and after confinement was blind 
in the left eye. Doctor W. F. Holcombe, of 
New York (said to be the first to use the 
ophthalmoscope in America, and to occupy a 
chair of ophthalmology here), explored the 
eye and found retinal apoplexy with dropsi- 
cal effusion. Tracing it out he found albu- 
men in the urine, and treated the lady on the 
principles I have laid down. By his kindness 
I saw the patient when her child was about 
three months old. The ophthalmoscope re- 
vealed the dropsical effusion to be absorbed 
and the fibrinous clot lying on the retina. 
The microscope revealed oil in the blood and 
fatty leucocytes, fatty epithelia and casts in 
urine, which was also albuminous. The 
vision was partly restored. In December, 
1896, Doctor Holcombe told me her vision 
was normal. In the light of conventional 
treatment, this case is also one of the wonders 
of dietetics. Such instances should be so 
common as to cease to be wonderful. 

Case 37. — Miss , aged 55, had when 

a young woman all the physical signs of 
tuberculosis of the lungs. She was cured by 
diet and remained so until two or three years 
ago, when, after losses of property, with sick- 
ness and death in her family, she found her- 
self a lone single woman in her own house. 
Within a year she came under my charge 
again with Bright's disease of the lungs. 
There was dulness on percussion, cavernous 
respiration, pectoriloquy, emaciation, lung 
fibers in sputum; albumen, casts, and fatty 
epithelia in urine; blood did not reveal the 
morphology of tuberculosis. February, 1896, 
her oculist reported her eyes had been so 
poorly nourished that the vitreous bodies 
were fluid, or partially fluid, and filled with 
minute opaque spots; a little astigmatism and 
presbyopia.^ He prescribed reading glasses, 
but no other local treatment. The degener- 



167 

ation was dependent upon her general health 
becoming better or worse, — this is best ex- 
plained by systemic fatty degeneration. While 
under treatment her eyesight improved, as 
did also the physical signs except the albu- 
men. Cough continued, but no lung fibers 
were found in the expectoration. She died 
in November, 1896. There was no autopsy, 
as she lived in a different State. 

Case 38. — Ten years previous to this writing 
a young wife was treated for consumption; 
the diagnosis was unmistakable to her at- 
tendant physicians and their consultants, who 
were of the highest repute. She was in bed, 
pale, thin, wan, coughing hard; hemoptysis. 
Physical signs of cavities in both lungs; the 
morphology of the blood was not tuberculous, 
but it contained oil, and in the white blood- 
corpuscles were fat globules. The urine when 
examined revealed abundant fatty epithelia, 
casts, and two- thirds albuminous ! The fatty 
degeneration was entirely unsuspected till 
proved to exist by me. The treatment 
availed but little, as she was too far gone to 
carry it out. 

Case jp. — Miss , 40 years old, com- 
plained of hebetude and listlessness, inability 
of exertion, depression of spirits, averring 
that she never had been better and never 
would be; had good medical attendance. It 
was only by persistent urging on the part of a 
friend that she would see me at all. She was 
a very quiet little body. Extremities and 
surface generally cold. There was hyperes- 
thesia of vagina and uterus, which seemed 
fully to account for the symptoms, but when 
these were relieved the hebetude continued, 
and she would have given up treatment as 
useless but for the persistence of her friends. 
The blood was then carefully studied with 
the urine, and the stigmata of fatty degen- 
eration discovered; quantity small but posi- 
tive. An effort was made to remove the ab- 



i68 

normal signs, and success followed after some 
months by cure of the hebetude, which has 
lasted more than three years. 

Case 40. — Mr. , about 33 years old, 

was a fine healthy boy up to the age of six, 
when he almost died from measles; his 
mother affirms that he never was the same 
person afterwards, and his mental and intel- 
lectual faculties were stunted. He was more 
or less continually ailing; at one time had 
consumption, which was cured by systemic 
treatment; also enlarged tonsils, which were 
cured by surgery. About four years ago he 
had a difficulty of locomotion. It gradually 
increased until he could not walk unless sup- 
ported by an assistant, or by holding to a 
rail in going down or up stairs. The nude 
trunk standing was a torso. The right arm 
hung down so that the hand almost touched 
the floor. There was a symmetrical muscular 
atrophy of the body and limbs, and he suffered 
great pain in both. His blood showed oil, 
and fat in leucocytes; urine revealed albumen, 
casts, fatty epithelia, protoplasmic filamentous 
catarrh, — these stigmata were not all present 
at one time but appeared separately, dually, 
or triply, after treatment began. Several 
other physicians saw this case away from me, 
especially when he sojourned at the seashore, 
and all diagnosed incurable locomotor ataxia. 
One seeing him later, locomoting normally, 
said to him, " I don't believe you are cured, 
and won't believe it! " He was treated on 
the plans here given, and humanly speaking, 
without he would have died. 

As to his chirography (1896) it must be 
confessed that it is locomotor ataxic. The 
stigmata of fatty degeneration are absent, 
and his locomotion is normal; even the pains 
have gone. If my readers will not receive 
this history as to therapy, still it serves to 
evidence the masquerade and also that there 
is a prelocomotor ataxic state. 



169 

Case 41. — A recently retired business man, 
aged 74, complained of hearing his heartbeat 
so loudly at night as to wake him and keep 
him from sleeping. The cardiac area of 
dulness on percussion was enlarged; there 
was a slight souffle with the first sound; 
the sounds were somewhat muffled and dis- 
tant. His urine contained albumen, casts 
true and false, fatty epithelia, amyloid bodies 
occasionally; his blood oil, and fat in the 
white blood-corpuscles. It was quite difficult 
to persuade this man that he was ill — he had 
that confidence in his own knowledge and 
judgment common to patients with urinary 
catarrh. He came in to see me on the day of 
his death, and appeared quite well, though 
he presented the above stigmata, besides the 
urine was much loaded with bile and filamen- 
tous catarrh. He then decided to go on 
regular treatment. Being busy I did not 
make out his written directions, and he con- 
sented I should send them later; but before 
I had time to write them out I heard that he 
was dead. It appears that, in about two or 
three hours after leaving me, he walked by a 
banker's office on level ground in State 
street, Boston, bowed a recognition to a clerk 
at the window, immediately staggered, and 
would have fallen had not a passer-by caught 
him. At once the clerk ran out and found 
him dead. It was called " heart failure." 
This was true, but what made the heart fail ? 
By the above evidence it was fatty degenera- 
tion. It may be averred that there should 
be post-mortem evidence. It would have 
been well, but such an examination was not 
made, one reason being that I had returned 
to my home in New York. 

11 Heart failure n as a cause of death should 
always be qualified by naming the exciting 
cause. If the heart fails because of a bullet 
or sword piercing it, it would be so stated in 



170 

military history. Then why not in medical 
ethics? In the early part of the eighteenth 
century the " medics " did this better than 
now, for they gave the causes! 

The clinical lesson of Case 41 is that 
patients do not always appreciate the sit- 
uation, and that physicians also do not 
always appreciate the situation. With hind- 
sight it seems to me that I ought to have 
made more of the opportunity. He thought 
he appreciated the situation; so did I. 
When I wished several samples of his morn- 
ing urine, he wrote he did not know why 
I wished them, as there had never been 
anything the matter therewith, and this after 
I had told him that previous examinations 
had shown the above abnormalities. Could 
we have foreseen the future for a single day 
we both would have been more anxious and 
more careful. 

This case also teaches that physicians 
should communicate as far as possible the 
serious nature of such cases, and that, if one 
believes, he must make his patients also 
believe. Conventionalism conceals too much 
the fact of heart disease, because convention- 
alism believes it incurable. After what has 
been produced here in evidence, is it not the 
better way to signify with tact that the case 
is serious, but not incurable if the patient 
faithfully follows out directions? Once a 
lady came to me for examination as to heart 
disease. I found it. I told her. She was 
so indignant that she never came back. 



Case 42. — A man, aged 45, came under 
my care some two years ago because of 
extreme sensitiveness and pain in the ab- 
dominal cavity, and because of frequent 
diarrhoeas. His occupation was that of a 
street-car conductor. He was well-born 
and well-bred, but had suffered reverses 
in finances and also from family troubles; 
bachelor; had served in the navy and ma- 
rine service and had been in tropical 
countries a good many years. 

Examination of the blood showed free 
subdermal oil, fat in the white corpuscles, 
some ropiness and stickiness of the red 
corpuscles, with some crystals of pigment 
matters, and later on in his case cystine 
was found. 

The morphology and chemistry of the 
urine showed but little abnormality. 

It was some months later that I learned 
that he suffered from hemorrhages under 
the skin, which he recognized as black- 
and-blue spots; and also in cold weather, 
on hitting the hand, the slightest bruise 
would result in a running, open wound 
which it would take weeks to heal. This 
case has been under observation ever 
since. His general condition is vastly im- 
proved; the hemorrhagic condition of the 
skin has entirely disappeared. There has 
been an appreciable gain in weight and 
the diarrhoeas are much less frequent. 

This case is unquestionably one of fatty 
degeneration of the nervous system, as 
well as in the blood vessels. 

J. A. Cutter. 

Case 4.3. — Some three years ago a man, 
middle aged, married, German by birth, 
a mechanic by occupation, consulted me for 
a hemorrhagic condition of the skin which 
he had suffered with for over ten years. 



172 

At the time of my examination, from 
above the knees to nearly the ankles the 
color varied from red, blue, to black. He 
had worn rubber bandages and had been 
under much care for rheumatism. The 
morphology of the blood showed but little 
rheumatism, but, instead, the free subder- 
mal oil and fat in the white blood cor- 
puscles. The urine occasionally contained 
albumen, though I did not at any time 
find casts or fatty epithelia. He suffered, 
like the preceding case, from borborygmi, 
also from frequent and almost appalling 
diarrhoeas. The extraction of a tooth 
would result in a hemorrhage lasting from 
twelve to twenty- four hours, necessitating 
the care of a surgeon. The diagnosis was 
made of haematophilia. He was treated by 
systemic plans, eating almost wholly 
broiled beef preparations. His skin hem- 
orrhages ceased after about six months 1 
treatment. He is now working as a me- 
chanic. A tooth extracted about a year 
ago resulted only in the ordinary hemor- 
rhage after such an operation. 

J. A. Cutter. 

December, 1897, fell 45 feet in a build- 
ing, landing supine ; no bones broken. 
Now apparently well. 

Case 44. — Some two years ago a widow, 
aged 40, consulted me for tic douloureux, 
from which she had suffered intermittently 
for three years. The spasms of pain oc- 
curred on the right side of the face, occa- 
sionally going slightly to the left; the 
mouth would be drawn to one side, and 
during the exacerbations of pain the right 
side of the face would, so to speak, sweat 
fat. 

She had buried her husband some five 



i?3 

years previously, after a long illness of 
consumption. Her friends had complained 
of her as being listless and lazy for a 
number of years, yet she met her duties 
nobly. 

The blood showed free subdermal oil, 
fat in the white blood corpuscles, with 
slight tendency to rheumatism, as shown 
by a small increase in the fibrin filaments, 
some huddling of the red blood corpuscles, 
and some salts present in crystalline form. 
The heart was somewhat enlarged and 
weakened, the urine bilious, with more or 
less of albumen. A diagnosis was made 
of systemic fatty degeneration. 

She did her own work, her two daugh- 
ters of 14 and 12 being at school. Treat- 
ment systemic ally adopted, and she 
lived as closely as she could upon broiled 
beef with but little vegetable food. 
Local treatment was followed for a sym- 
metrical enlargement of the womb; but 
little medicine given her, as strychnine 
upset her, and anodynes of various kinds, 
like codeia, cannabis indica, clogged her 
liver and brought back albumen into the 
urine. These anodynes did not control 
pain, but only made it worse because of 
this clogging; of this matter more later. 

The medicines which agreed the best 
were digitalis and the pyrophosphate of 
iron. 

She improved in the course of eighteen 
months, although her treatment was under 
great disadvantage, and she was not often 
seen, as she lived fifty miles from New 
York. In the spring of 1897, March, she 
had a ferocious attack of tic douloureux, 
from which she and I both thought she 
had recovered. This pain followed her 
up so long that I finally made her take an 
anodyne in the following shape: 



174 

One of Fraser's tablets, containing £ of 
a grain of morphine, -^ of a grain of 
atropia, and -g-^ of a grain of hyoscine 
hydrobromate, placed in a glass three- 
quarters full of water. She was instructed 
to take teaspoonful doses every minute 
until relieved. These small doses after 
a time relieved her, and she then followed 
up the medicine with salts to act on the 
liver. 

It seems that she had been overworking, 
lifting, and straining. 

She now suffered from difficult vision in 
the left eye — that is, the eye opposite to 
the facial neuralgia. Examined some 

weeks later by . He informed me 

that there was detachment of the retina, 
and feared there was a tumor of the cho- 
roid. She was examined again by this 

same gentleman in August, and by , 

of New York, and they both were positive 
that there was a tumor present and that 
it was probably a sarcoma, and immediate 
operation was advised. 

Consulting with my father, Dr. Ephraim 
Cutter, it was thought best to wait awhile 
to see if the condition of the eye would 
improve, for we both believed that this 
was simply an evidence of fatty degenera- 
tion. 

In October I saw her, with Dr. — -, and 
we found that the growth was increasing; 
no pain or discomfort in the eye, but the 
evidence was positive that the eyesight 
was forever ruined. It was decided to 
enucleate the eye, which was done, under 
ether, November, 1897, 

A careful microscopical examination of 
a portion of the tumor by my father and 
myself showed it to contain absolutely no 
heterologous elements, and therefore nega- 
tived a diagnosis of cancer in any of its 



i7S 

forms. Instead, the growth was made tip 
of low-grade tissue, almost altogether fat. 
So this woman was again suffering from 
fatty degeneration. 

Good had been done by the moral effect 
of the demonstration that there was no 
cancer about her eye. She may now go 
on and have better times and finally re- 
cover from her enemy which has been 
pursuing her for so many years — in fact, 
from girlhood, if I judge rightly her his- 
tory. 



Partial Bibliography.* 

£PHRAIM CUTTER, M.D., LL.D., 

Corresponding Member Belgian and Italian Micro- 
scopical Societies and Gynaecological Society of 
Boston; Member Massachusetts Medical 
Society, American Medical Asso- 
ciation, etc., etc. 

The Pre Apoplectic State. New York State Med- 
ical Reporter, June, 1896. 

Preventive Medicine in Apoplexy. Journal Ameri- 
can Medical Association, 1896. 

Feeding against the Appetite. Medical Register, 
Philadelphia, Pa., April 2d and 9th, 1897. 

Trophopathy in Fatty and Fibroid Degenerations. 
Jointly with John A. Cutter, M.D. Virginia Medical 
Monthly, January, 1890; Southern Practitioner, Feb- 
ruary, 1890; Medical Bulletin, January, 1890; N. E. 
Medical Monthly, February, 1890; Journal Am. Med. 
Association, February, 1890; Dietetic Gazette, De- 
cember, 1889; The Doctor, September, 1889; London 
Lancet, vol. i., 1890. 

Feeding in the Wasting Diseases. Joint report to 
Committee of Dietetics of Am. Med. Association, 
1890, with Dr. John A. Cutter. Journal of Am. Med. 
Association, July 26th, 1890; Med. Bulletin, June, 
July, and August, 1890; N. E. Med. Monthly. August, 
1890; Pac. Med. Journal, August, 1890; Southern 
Practitioner, July and August, 1890; Virginia Med. 
Monthly, June and July, 1890. On (1) Consumption, 
one hundred cases; (2) Bright's Disease, Fibroid 
Tumor, and Cancer; (3) Male Neurasthenia. 

A New Sign of the Pre-Embolic State. Chicago 
Med. Journal, February, 1879. 

Food as an ^Esthetic, Chemic, Physiologic, Patho- 
logic, and Therapeutic. Am. Journal of Dental Sci- 
ence, January and February, 1880. 

Partial Syllabic Lists of the Clinical Morphologies of 
Blood, Sputum, Faeces, Urine, Foods, Clothing, Soils, 
etc. Book. Published by Auther, 1888. 

The Esoteric Beauty and Utility of the Microscope. 
Journal of the Amer. Med. Ass'n, May 7th, 1S92. 



♦Titlctof contributions to diseases of women, diseases of 
the throat, galvanism, etc., though collaterally cornected 
with subject, are not here listed. 

177 



178 PARTIAL BIBLIOGRAPHY. 

The Therapeutical Drinking of Hot Water: its 
Origin and Use, Am. Med. Weekly, January 8th, 
1883; Druggists' Circular, August, 1883; London 
Lancet, September 15th, 1883; Journal d'Hygiene, 
October 25th, 1883; Therapeutic Gazette, Scientific 
American, Constitutionnelle, and the medical and 
secular press of Paris. 

The Pre- Rheumatic and Pre-Embolic States. The 
Medical Bulletin, Philadelphia, April, 1897. 

Cystine. The Medical Bulletin, June, 1896. 

The Fatty and Fibroid Degenerations. Jointly 
with John A. Cutter, M.D. The Journal of the Ame- 
rican Medical Association, 1892. 

Fatty Degeneration and its Masquerades. The 
Medical Age, Detroit, October 10th, 1895. 

Medical Food Ethics Now and to Come. Secre- 
tary's Address, Section Physiology and Dietetics, Am. 
Med. Ass'n, 1892. The Journal of Assoc, 1893. 

Food, Nervousness, and Divorce. Therapeutic Ga- 
zette, August, 1880. 

Food as a Medicine in Uterine Fibroids. American 
Journal of Obstetrics, October, 1877. 

Food and Uterine Fibroids. International Med. 
Congress, Berlin, 1890. 

Diet in Cancer. Albany Med. Annals, July- 
August, 1887. 

Treatment of Consumption by Animal Food. Bos- 
ton Journal of Chemistry, January, 1876. 

Treatment of Consumption. Transactions Am. Med. 
Ass'n, 1880, pp. 76. Seventy cases reported. 

Food. An open letter to J. Marion Sims, M.D.> 
LL.D. Gaillard's Med. Journal, New York, Febru- 
ary, 1881. 

Food and Tubercle. International Med. Congress, 
Berlin, 1890. 

Count Rumford as Cook. Woburn Journal, May 
30th, 1890. 

Food as a Medicine in Typhoid Fever and in 
Laryngeal Growth. Middlesex S. Dis. Med. Society, 
Massachusetts, May, 1877. 

Food in Nervous Affections. Journal of Am. Med. 
Association, 1888. 

Food in Motherhood. Book. D. Stott, 370 Oxford 
street, London, January, 1890. Out of print. 

Heart Disease and Feeding. Open letter to W. T# 
Gardner, M.D., LL.D., Glasgow. Albany Medical 
Annals, September, 1888. 



PARTIAL BIBLIOGRAPHY. 179 

Vinegar and Vinegar Yeast. Times and Register, 
Philadelphia, July, 1889. 

Diet List for Lactation. Michigan Med. News, 
August, 1880. 

Feeding of Nursing Children. Virginia Med. 
Monthly, August, 1880. 

Food in Agalaxia. American Journal of Obstetrics, 
New York, April, 1878, 

Candy. Boston Journal of Chemistry, April, 1876. 

Diseased Teeth. Youth's Companion, Boston, De- 
cember, 1886. 

Teeth and Flour. American Journal of Dental 
Science, November, 1878. 

Is Flour our Proper Food? Trans. New Hampshire 
State Med. Society, 1875; The Doctor, New York, 
January and February, 1890. 

Does the Use of Flour Promote the Decay of Teeth? 
Boston Journal of Chemistry, December, 1874. 

Does the Use of Flour Promote Affections of the 
Nervous System? Boston Journal of Chemistry, Feb- 
ruary, 1875. 

Asthenic Disease and Flour. Boston Journal of 
Chemistry, April, 1873. 

Examination of Flour. Boston Sunday Herald, 
December 5th, 1880. 

Whole Wheat Cleaned. Popular Science News, 
Boston, January-February, 1888; Home Missionary; 
S. Sc, London, June, 1888. 

Sugar. Annals of Hygiene, Philadelphia, April, 

1888. 

Butter. Michigan Med. News, June 25th, 1881. 

List of Food Stuffs under the Microscope Cincin- 
nati Medical News, March, 1881. 

Highly Important and Extensively Advertised Cereal 
Foods under the Microscope. Twenty-eight cuts. 
Am. Med. Weekly, January 7th, 1882, edition 260,000; 
Scientific American; also newspapers. 

Flour. Gaillard's Med. Journal, 1882. 

Tubercle Parasite. Am. Med. Weekly, May, 18S2; 
Christian Advocate, June 1st, 1882. 

A New Clinical Microscope. Boston Journal of 
Chemistry, April, 1869. 

Amoeboid Movements of the White Blood Corpus- 
cle. Boston Journal of Chemistry, June, 1S76. 



l8o PARTIAL BIBLIOGRAPHY. 

Tolles' One-Seventy-fifth Inch Objective: its His- 
tory, Uses, and Construction. Am. Journal of Arts 
and Sciences, New Haven, August, 1879; Scientific 
Am. Supplement. Translated into French and pub- 
lished in Journal de Micrographie, Paris, 1879. 

Primer of the Clinical Microscope. Virginia Med. 
Monthly, August and September, 1879. Pamphlet. 

A New Physical Sign of the Pretubercular State. 
1877. Illustrated. 

Morphology of Syphilitic Blood. Am. Journal of 
Dental Science, October, 1879. Reprint. 

Throat Syphilis and Tubercle according to Salis- 
bury. Archives of Laryngology, New York, Decem- 
ber, 1880. 

Use of the Microscope in Consumption. Diagnosis 
of Necrosis and Disintegration. First paper. Journal 
of Microscopy, Phin's, September, 1881. 

Use of Microscope in Consumption. Second paper. 
Necrosis of Lung. Differential Diagnosis. Am. 
Journal of Microscopy, Phin's, 1882. 

Crypta Syphilitica. Monographia Syphilitica. 
September, 1888. 

On the Morphology of Rheumatic Blood. Phila- 
delphia Med. Times, February, 1889. 

Under what Circumstances Do the Usual Signs Fur- 
nished by Auscultation and Percussion Prove Falla- 
cious? Boylston gold medal prize essay, 1857. 

A New Resting and Invalid Chair. Chicago Med. 
Journal and Examiner, September, 1877. 

The Relations of Medicine and Music. Circular of 
Information, U. S. Bureau of Education, Washing- 
ton, D. C, 1886. 

The Relation of Medicine and Music. Read to 
Society of Sc, Letters, and Art, London, November, 
1880. Published 1891. 

Relations of Music and Medicine. Rewritten. 
Albany Medical Annals, November, 1888. 

Music and Athletics. Journal S. Sc, London, No- 
vember 20th, 1889. 

Food and Music. Dietetic Gazette, January, 1890. 

The Voice in Speech, Song, and Whisper. Voice, 
New York, July, 1890; New York State Music Teach- 
ers' Association Transactions, 1890. 

Report on Flour and Decayed Teeth. Mass. State 
Board of Health, 1875. 



APPENDICES. 

APPENDIX A. 

"An Invalid's Chair." 

{Extract from the English Mechanic and World of 
Science, London , Jan. Jth, 1876.) 

"The New Chair invented by Dr. Ephraim CuTTfcR, 
and represented in the annexed illustration, [p. 182], 
involves some novel features which are not to be found 
in similar devices. The back of the chair, the seat, 
and the leg portion have each an independent motion 
in vertical planes, corresponding to the motions of 
the great natural divisions of the human body. The 
arrangements allow of the variety of changes which are 
found existing in the human body in a state of perfect 
rest. Having made the adjustments, the whole series 
of inclined planes can be made to revolve about a 
common centre, and the weight of the body can be 
thrown from one division on to another, or distributed 
equally over the entire body surface. At the same 
time the chair allows of the motion of the hip and knee 
joints. An endless screw gear secures the equable, 
firm, and certain movement, with no fear of detach- 
ment or breakage under ordinary usage. The feet 
may be easily raised higher than the head, thus allow- 
ing the return of the blood from the extremities by 
reversing the hydrostatic pressure of the column of 
blood in the veins — a very desirable arrangement in 
cases of cardiac disease." 

See pages 112, 113, 114. 
181 




l82 



APPENDIX B. 

Varieties of Sugar. 

g s= glucose group, s = saccharose group. 



Name and Group. 

arabinose, g 
dambose, g 
dextrose, g 
eucalyn, g 
galactose, g 
inosite, g 
lactose, s 
levulose, g 
maltose, s 
meligitose, s 
melitose, s 
mycose (ergot sugar) 
saccharose, s 
scylite, g 
sorbin, g 
synanthrose, s 
trehalose, s 



Origin. 

Gum arabic 

Dambonie 

Vegetables, honey, etc. 

Melitose 

Milk-sugar 

Flesh, etc. 

Milk 

Fruits, etc. 

Malt 

Larch-manna 

Australian manna 

Fungi, as ergot 

Sugar-cane, beet, etc. 

Fish, etc. 

Mountain ash berries 

Dahlia and other tubers 

Terhala manna 



(From Standard Dictionary.) 



183 



APPENDIX C. 

Doctors' Offices in Business Buildings. 

Equitable Building, 120 Broadway, 

New York, February ist, 1896. 

To the Editor of the New York Medical Journal: 

Sir: Your comment in the current number of the 
Journal, on physicians occupying office buildings, 
prompts me to write that for over three years my office 
for consulting has been in the Equitable Building, and 
that my experience justifies me in commending the 
action of the Metropolitan Life Insurance Company in 
preparing to rent to reputable physicians. One of the 
advantages is that of removing one's work in great part 
from contact with one's family; women like this es- 
pecially, as there is an impersonality about a great 
office building nowhere else obtainable; moreover, the 
physician obtains quarters in a splendidly fitted build- 
ing, with surroundings equal to those of many a 
palace. In the great insurance company buildings, the 
woodwork alone is of the highest order. It should 
be saving of money, as one can live in a more modest 
home, and not as his business increases swell out into 
larger establishment, such "swelling" being the 
downfall of many medical men financially. 

There is an ethical consideration : the ' ' great " 
physician with an immense income does not do as 
good medical work as the man that earns much less, 
other things being equal as to education and natural 
ability. The laity think the opposite, and if they 
find a physician's office crammed full of patients, he is 
their man. Now, the coming practice of medicine is 
to be in large part the more careful handling of 
chronic diseases; such handling takes time, and as 
soon as the laity realize that a physician will do better 
work who manages but a few patients, the better it 
will be for all concerned. The aggregation of doctors 
in a first-class office building will tend toward this de- 
sirable end as placing all on a common level. 

Medical men work altogether too long each day, and 
live altogether too short lives. To go home from the 

184 



ts$ 

office and know that a great part of the day's work is 
done, and that one will not have to labor away into the 
evening, is a fine thing. 

Educate the people to know that, except in case of 
emergency, which we are always prepared for, the 
office work is to be done at certain hours in one place, 
and the doctor will have more rest and time to see his 
family, bring up his children in the way they should 
go, and receive the admonitions of his wife. 

Other advantages are a fireproof and carefully 
watched building, and good attendance as to cleaning. 

The only objection is the necessity of two addresses. 
It seems to me that, as the Metropolitan Company are 
fitting up for a large number of doctors, special 
arrangements could be made whereby telegrams re- 
ceived after office hours would be forwarded by the 
superintendent to the homes of the persons addressed. 

I wish to say one word as to so-called waste of 
money in the great insurance company buildings. 
From my personal observation down -town, I believe 
that the insurance companies have invested the 
money of the policy holders most wisely; " the best is 
the cheapest "; they have used the best as to material, 
and have not hesitated to get enough light and air. 
This cannot be said of some buildings put up by rich 
men for investment ; they have scrimped so as to ma- 
terial and space that their investment, I think, does 
not pay as it otherwise would. 

Finally, all hail the time when medical men will not 
be in contact with patients more than eight hours a 
day! John A. Cutter, M.D. 

(From the Ntw York Medical Journal, February 
22d, 1896.) 



INDEX. 



Abnormal fatty ills, 3, 3a 

Acute fatty degeneration, 3a 

Adipocere, 2 

Air, 102, 103 

Albumen in urine, 66, 67 

Albuminuria retinitis, a masquerade, 45, 46 

Alcohol, avoid, 82, 83 

Alcoholic and acid yeasts in all animal and vegetable 

foods, 84 
Alcoholism, a masquerade, 4 
acute results of, 4 
cases of, 151, 152 
Althaus, 120 

Amaurosis, a masquerade, 4 
case of, 140, 141 
American Electro-Therapeutic Association, 108 

Neurological Association, 55 
Amyloid, a masquerade, 5 
bodies in brain, 1 
in urine, 70, 71 
Anaemia, pernicious, a masquerade, 42 
Angina pectoris, a masquerade, 5, 6, 7 

pectoris, case of, 141, 142 
Aphasia, a masquerade, 7 
Apoplexy, a masquerade, 7, 8 
and hemiplegia, 33 
and paraplegia, 41 
cases of, 149, 150 
death from, 142 
retinal, a masquerade, 8, 9 
with Bright's disease, 49 
Arcus senilis, a masquerade, 9 
Arthritis deformans, case of, 157 
Asthma, 87 

cases of, 145, 147 
Atheroma, a masquerade, 9, 10 
Avoid fatty foods, 81, 82 

yeasts in all animal and vegetable foods, 84 

Basedow's Disease, a masquerade, 52, 53 
Beef, a quickening food, 87, 88 

187 



l88 INDEX. 

Berlin Medical Congress, 44 

Billings, Judge, 97 

Blaine, James G., 130 

Bleeding, excessive, a masquerade, 32 

Boston, 140 

Brain, softening of, a masquerade, 54, 55 

Bright's disease, 4, 5 

disease, acute, 13 ^ 

disease and convulsions, 44 

disease, cases of, 140, 141, 145-166 

disease caused by shock, 53 

disease of kidneys and albuminuric retinitis, 

45, 46 
disease of the kidneys, a masquerade, 10, 11, 

12, 13, 29 
disease of the lungs, 166, 167 
disease of the lungs, a masquerade, 13, 14 
disease in scarlet fever, a masquerade, 49, 50 

British Medical Association, 96 

Butter, melted, to be studied, 64 

Breasts, epithelia of, 1 

Calculi, 87 

kidney, 106, 107 
Cancer and fatty degeneration, a masquerade, 50, 51 

cases of, 153, 154 
Canon Harford, 129, 130 
Carbonic acid causing death, 80, 81, 115 
Cases, 140-172 
Casts of kidney tubes in urine, 68--70 

pseudo, in urine, 70 
Catalepsy, a masquerade, 15, 16 

cases of, 142, 143 
Cataract, 142 

a masquerade, 16, 17 
Catarrh, urinary, 72-75 
Causation, see Definitions 
Celsus, 135 

Chair, Cutter, 112-114, Appendix A 
Charles Theodore, Duke of Bavaria, 46 
Cbickering, Rev. Dr. J. C, 140, 141 
Chenopodium ambrosioides, 52 
Christ's death due to heart rupture, 47 
Circulation to be quickened, 84-88 
Clarke, President, 107 
Climate, 91, 92 

Clinician must understand micrography, 82 
Codman, Dr. B. S., 53 
Codman & Shurtleff, 53 
Colds, treatment of, 86 
Concretion, intestinal, a masquerade, 19, 20 
Conference of force, 95-101 



INDEX. 189 

Confidence lost, 95 
Conservation of vital force, 88-90 
Constipation, 132, 133 
Consumption, cases of, 156, 157, 164 

of the bowels, case of, 149 
Convulsions in Bright's disease, 44 

puerperal, 42-44 

puerperal, a masquerade, 42-45 
Cooke, Prof. JosiahP,, 65, 108 
Corpora lutea, 1 
Courage, 92, 93 
Crypta syphilitica, 56, 57 
Cutter, Dr. Benjamin, 11 

E. P., 124 
Cystinsemia, 15 

Da Costa, Dr., 30 

Dana, Dr. C. L., 55 

David, King, 129 

Davy, Sir Humphry, 98 

Death from heat, a masquerade, 30-32 

Debility, general, a masquerade, 20 

Definitions, ix-xiv 

Delmonico banquet, 28 

Dementia, a masquerade, 20-22 

D'Etoille, Terry, 120 

Diabetes, cases of, 148, 164, 165 

Diagnosis, 61-79 

Dieta literarum, 129 

Diphtheria, a masquerade, 22 

Diseases due to old age, 1 

Doctors' offices in business buildings, Appendix C 

Dogiel, Professor, 128 

Dress, 108-111 

Dropsy, a masquerade, 22-25 

Electricity, 118-125 
Elsberg, Dr. Louis, 14, 29, 119, 120, 150 
Embolism, a masquerade, 17-19 
Epilepsy, a masquerade, 25, 26 

cases of, 143-145 
Epithelia of breasts, 1 

of sebaceous glands, 1 
Epithelial cells of kidneys, 1 
Exercise, 90, 91 
Eye disease, a masquerade, 4, 5 

cases of, 140, 141 

fatty tumor of, 174 

Facial neuralgia, 6 

neuralgia, a masquerade, 57 



I90 INDEX. 

Facial neuralgia, case of, 173 

Faith in God, 95 

Fat, free subdermal, in blood specimens, 61, 62, 

63 
in white blood corpuscle, 63, 64 
office of, in healthy body, 2 
omental, 2 

thrombi and emboli of, 64 
Fatty degeneration, acute, 36 

degeneration a preventive process, 6o, 
degeneration, diagnosis of, 61-79 
degeneration in lean people, 2 
epithelia in urine, 67, 68, 75 
foods, avoid, 81, 82 
heart, 3 

ills, abnormal, and recognized as fatty degenera- 
tion, 3, 3a 
ills, masquerades, 30-60 
liver, 3 
Ferguson, Dr. A. H., 27 
Fibres of Miiller, 46 
Fibroid and sclerotic degeneration, 84 
Field, Prof. H. M., 121 
Forster, 46 

Fox, Dr. L. Webster, 46 
Fruits must be fresh, 83, 84 

Gall stones, a masquerade, 26-28 
Galvanism, uterine fibroids, 123 
Gangrene, senile, a masquerade, 51, 52 
Garfield, President, 113 
Gases from meat indigestion, 84 
General debility, a masquerade, 20 

hyperesthesia, a masquerade, 33-38 
Gettysburg, 92 
Glaucoma, case of, 14 
Gout, 87 

Graafian follicles, 1 
Grant, General, 92 
Guy's hospital, 98 

HiEMATOPHlLiA, a masquerade, 32, 
cases of, 152, 171 
Harvard, 11 

Hathaway, Mr. A. K., 11 
Haven of health, 129 

Heart diseases, cases of, 141, 142, 153, 161, 162, 169, 
170 

failure, a masquerade, 28-30 

fatty, 3 

ruptured or broken, a masquerade, 14, 15 



INDEX. 191 

Heart, strengthen, 111-116 
Heat, 101, 102 

death, a masquerade, 30-32 
Hebetude, a masquerade, 32 

cases of, 154, 167, 168 
Heck, Dr., 55 
Hemiplegia, 21 

a masquerade, 33 
Heubner, Prof., 55 
Hoffman's anodyne, 114 
Holcombe, Dr. W. F., 166 
Hospital, The, 91 
Hot water, 84-87 
Hyperesthesia, general, a masquerade, 33-38 

Ideas, stimulus of, 92, 93 
Insanity and dementia, 20-22 

a masquerade, 38 
Intestinal concretions, a masquerade, 19, 20 

Jones, Prof. Joseph, xii, 24, 58, 119 

Dr. McNaughton, 4 
Journal American Medical Association, 27 

der Praticien, 52 

Kazan, Russia, 128 
Kidneys, epithelial cells of, 1 
Kidneys (see Bright's disease) 
Kimball, Dr. Oilman, 136 
Rev. Peter, 127 

Laziness, a masquerade, 32 

Lean people suffer from fatty degeneration, 2 

Liegeois, M., 52, 53, 55 

Life a question of expenditure of vital force, 89 

Light, 117, 118 

Listlessness, a masquerade, 32 

Liver, fatty, 3 

Locomotor ataxia, a masquerade, 39, 40 

ataxia, cases of, 146, 157, 162, 163, 168 

ataxia (see Sclerosis), 59 
Lungs, Bright's disease of, a masquerade, 13, 14 

Management, 134, 135 

Marcy, Dr. II. O.. x 

Maryland Medical Journal, 55, 56 

Masquerades of fatty ills, 30-60 

Massachusetts Agricultural College, 107 

Massage, good done by conference of force, 99-IOI 

Medical club at Vienna, 55 

Times and Register, 45 



192 INDEX. 

Medicine, 112 

Medicines, 131, 132 

Melancholia, a masquerade, 4 

Michael, 46 

Micrographic Dictionary, 3, 9, 61 

Mliller, fibres of, 46 

Milk, to be studied, 64 

Mitchell, Dr. S. Weir, 4, 16, 142 

Morphology of puerperal discharge, I 

of the urine, 65-70 
Motherhood, food in, 44 
Muscle, rupture of, a masquerade, 46, 47 
Muscular fibre, morphology of, 64 
Museum, Royal College of Surgeons, London, 19 
Music, 126-131 

Nature cures, 79, 135-139 
Neuralgia due to fatty ills, 38 
facial, 6 

facial, a masquerade, 57 
facial, case of, 173 
Neurasthenia, a masquerade, 40, 41 

cases of, 146, 148, 149, 163, 164 
(see Catarrh, urinary) 
Newman, Dr. Robert, 119 
New York Medical Journal, 3a 

York Tribune, 30 
Ninth Massachusetts Battery, 92 
Normal fatty degeneration, 1 

Obesity, 2, 3 
Oil, free, in urine, 72 
to be studied, 64 
Osier, Prof., 139, 140 
Ovarian subinvolution, 1 
Oyster, raw, causing acute fatty degeneration, 3a 

Palsy, shaking, a masquerade, 52, 53 

Paralysis agitans, a masquerade, 52, 53 

Paraplegia, a masquerade, 41 

Paresis, a masquerade, 41, 42 

Pepper, Dr., 30 

Pernicious anaemia, a masquerade, 42 

Physical signs, 75-79 

Pigment matter in blood morphology, 64, 65 

Pilate, 47 

Pitt, the elder, 96 

Premature old age, 3 

Preservative process in fatty degeneration, 60, 61 

Protoplasm, force of, 106, 107 

Pseudo-casts in urine, 70 



INDEX. 193 

Puerperal convulsions, a masquerade, 42-45 
discharge, morphology of, 1 

Rest, 88-90 

Retinal apoplexy, a masquerade, 8, 9 

apoplexy, case of, 166 
Retinitis, albuminuric, a masquerade, 45, 46 
Rheumatism, 87 

Richardson, Sir B. W., II, 141, 142 
Robbins, Dr. Henry A., 55, 56 
Roberts, 139, 140 
Rosenstein, 139, 140 
Rottenburger, John, 129 

Royal College Surgeons (London) Museum, 19 
Rumford, Count, 76 
Ruptured heart, a masquerade, 14, 15 
Rupture of muscle, a masquerade, 46, 47 

of uterus, a masquerade, 47-49 

Saviour, 96 

Sayre, Prof. Lewis A., 109, 112 

Scarlet fever, 104 

fever and Bright's disease, case of, 159 
fever with Bright's disease, making a masque- 
rade, 49, 50 

Sclerosis, a masquerade, 50 

Sebaceous glands, epithelia of, 1 

Seidlitz powder causing death, 80 

Senile gangrene, a masquerade, 51, 52 

Shaking palsy, a masquerade, 52, 53 

Shattuck, Prof. G. C, 11 

Shock, a masquerade, 53, 54 

Sims, Dr. J. Marion, 29 

Skin, hygiene of, 103-108 

Small-pox with fatty degeneration, a masquerade, 54 

Smithsonian contribution to knowledge, 24 

Softening of brain, a masquerade, 54, 55 

Special and particular treatment, with illustrative 
cases, 140-175 

St. Cecilia's Guild, 130 

Storer, Dr. D. Humphreys, 49 

Strengthen the heart, 111-116 

Subinvolution, ovarian, 1 
uterine, 1 

Sugars, list of, Appendix B 

Summer heat, proper food in time of, 31, 32 

Syphilis, a masquerade, 55-57 

Tarchanoff, Prof., 126 
Thrombi of fat, 64 



194 INDEX. 

Thrombosis, a masquerade, 17-19 
Tic douloureux, a masquerade, 57 

douloureux, case of, 172 
Tissues, fatty degeneration of, 3, 3a 
Tokio, University of, 155 
Treatment, 79-139 

special and particular, with illustrative 
cases, 140-175 
Tremor, a masquerade, 52, 53 
Tuberculosis, fatty masquerade in, 57, 58 
Turtles, production of dropsy in, 24, 25 

University of Pennsylvania, 30 

Urine, morphology and chemistry of, 65-75 

Uterine fibroid, cases of, 147, 148 

fibroids, galvanism of, 123 

rupture, a masquerade, 47-49 

subinvolution, 1 

Vander Emde, Henry, 30 
Vital force, conservation of, 88-90 

Warren Academy, ii 

Water-gas poisoning, acute fatty degeneration, 3a 

hot, 84-87 
Westminster Abbey, 130 
Wheeler, Dr. M. G., 25 
Whitney, Commodore W. I., 53 
Will, 93 

Windom, Secretary, 28, 29 
Worry, 93, 94 

Yandell, Dr. L. P., 56 

Yeasts, alcoholic and acid, in all foods, 84 

Yellow fever, fatty degeneration masquerade in, 59 



BOOKS, PAMPHLETS. 



A. The Fatty Ills and their Masquerades. 
Cloth. Pp. xiv-194. Price, $1.00. 

B. The Clinical Morphologies of the Blood, Spu- 
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Potable Waters, Ice, and the Air), the Clothing, Uterine 
and Vaginal Discharges, and Soils; with list of lantern 
slides. $1.00. 

C. The Galvanic Treatment of Uterine Fi- 
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cents. 

I. (1) Cutter's Stem Pessary. (2) Electroly- 
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1890. (4) Cleaned Whole Wheat. (5) What 
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J. Food in Motherhood. Out of print. Expect to 
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K. Cutters' Medical Memoirs. In Preparation. 
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Address 

Ephraim Cutter, M.D., John A. Cutter, M.D., 

EQUITABLE BUILDING, 120 Broadway, 
NEW YORK. 

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CUTTERS' SCHOOL OF 
MICROLOGY. 

For Physicians only. First taught in 1869. 

Principal: EPHE1IM CUTTER, LL.D., 

M.D. Harr. 1856, Unir. Penna. 1857. 
Assistant : JOHN ASHBUBTON CUTTER, B.Sc, 

M.D. Albany, 1886. 

Lessons, one hour each. Terms, $200.00, in advance, 
for course. 

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SYLLABUS OF LESSONS IN CLINICAL 
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I. Potable Waters. Mode of collecting. Alg^e, 
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Oscillatoriaceae, Protococcaceae, Palmellaceae. II. 
Fungi, Yeast, Alcoholic and Vinegar; Bacteriaceae, 
Vibriones, Leptothrix. Protoplasms, Amoebae, In- 
fusoria, Rhizopods, Asthmatos Ciliaris. III. Foods. 
Bread, Crackers, Infants' and Invalids' Foods, Changes 
in Food by Cooking. IV. Dirt, Air. V. Urine. VI. 
F^ces. VII. Sputum, Vomitus. VIII. Healthy 
Blood. IX. Clinical Morphology of Skin. X. 
Tuberculosis. The Pre-tubercular State— Blood, 
Sputum, Faeces, Urine, Skin. XL Syphilis. The Blood 
and Urine. XII. Rheumatism. The Pre-rheuma- 
tic State— Blood and Urine. XIII. Asthma, Hay 
Fever, La Grippe — The Sputum. XIV. Thrombo- 
sis and Embolism. The Pre-embolic State— The 
Blood. XV. and XVI. The Fatty and Fibroid 
Degenerations and their Masquerades. Bright's 
Disease, Diabetes, Enlarged Liver, Stomach and Heart, 
Atheroma, Apoplexy, Paralysis, Locomotor Ataxia, 
Cataract. The Pre-apoplectic State— The Blood, 
Sputum, Urine, Faeces, and Skin. XVII. Malaria. 
Blood, Urine, Skin, and Sputum. XVIII. Male 
Neurasthenia. The Urine. XIX. Consumption 
of the Bowels. XX. Review. Special reference to 
diagnosis of diseases mistaken for others. Uterine Dis- 
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The Physician is taught how to use his microscope 
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and the diagnosis of the diseased conditions, with the 
positive management of such that a certain percentage 
are permanently ameliorated, are amongst the duties of 
thejphysician. 

196 



Cutters* Medical Memoirs 

TO CONTAIN. 

I. The Technique of the Micro- 
scope. 

II. The Germ Diseases. 

III. The Fatty Ills. 

IV. The Fibroid Ills. 
V. The Gravel Ills. 

VI. The Ills Due to Fibrjemia 
and Allied Conditions. 

VII. The Cancerous or Malignant 
Ills. 

VIII. Food in Motherhood. 

IX. Diseases of Women, Specially 
in the Line of Work Estab- 
lished by the Senior Writer 
in 1868 as to Management of 
Uterine Displacements. 

X. Ethics and Polemics of Medi- 
cal Practice, Specially as 
to the Management of Chron- 
ic Disease. 

XI. Music, Galvanism, etc. 

It is hoped : to issue the above dur- 
ing 1898. The writing will be on the 
line of practical work in medicine as to 
diagnosis and management of disease. 

SUBSCRIPTION PRICE, #5.00. 

EPHRAIM CUTTER, M.D., 

JOHN ASHBURTON CUTTER, M.D., 

120 Broadway, Equitable Building:, 
New York, 

197 



